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Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized end-stage renal disease patients on hemodialysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Colonic perforation is a rare complication during colonoscopy. A recent single center study reported a high incidence of colonic perforation in end-stage renal disease (ESRD) patients on hemodialysis (HD) who underwent colonoscopy. We sought to determine nationwide, population-based prevalence in rates of colonic perforation during colonoscopy among ESRD inpatients on HD in the US, and to assess risk factors for colonic perforation in this patient population.

Methods

We obtained patient data from the Nationwide Inpatient Sample and used the International Classification of Diseases, the 9th revision, clinical modification codes, to identify ESRD patients on HD who had undergone colonoscopy in 2006. The control group consisted of inpatients who had colonoscopy without ESRD.

Results

Colonic perforations occurred in 51/17,000 ESRD hospitalizations on HD (0.3%) and 3,951/564,428 controls without ESRD (0.7%). The risk of colonic perforation among the study group was not significantly higher than the control group even after adjusting for patient demographics like age, gender and comorbid conditions (adjusted odds ratio [aOR] −0.55; 95% confidence interval [CI], 0.30–0.97). Older age (OR −1.007; 95% CI, 1.002–1.011) and female gender (OR −1.18; 95% CI, 1.03–1.36) were identified as independent risk factors for the risk of perforation in this population group.

Conclusions

There appeared no increased risk of colonic perforation during colonoscopy among inpatients who received HD in our study. Increasing age and female patients appeared to be associated with procedure-related colonic perforation.

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Abbreviations

CCI:

Charlson comorbidity index

ESRD:

End-stage renal disease

HD:

Hemodialysis

HCUP:

Healthcare cost and utilization project

OR:

Odds ratio

NIS:

Nationwide inpatient sample

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Conflict of interest

None of the authors declare any commercial conflict of interest.

Author contributions

Study concept, data monitoring, paper preparation and revisions—U. Navaneethan

Data monitoring and paper preparation—Preethi G.K. Venkatesh

Data monitoring and statistical analysis—Sravanthi Parasa

Study design, study concept and paper revisions—Bo Shen

Author information

Authors and Affiliations

  1. Digestive disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Udayakumar Navaneethan, Preethi G. K. Venkatesh & Bo Shen

  2. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Sravanthi Parasa

Authors
  1. Udayakumar Navaneethan
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  2. Sravanthi Parasa
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  3. Preethi G. K. Venkatesh
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  4. Bo Shen
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Correspondence to Udayakumar Navaneethan.

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Navaneethan, U., Parasa, S., Venkatesh, P.G.K. et al. Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized end-stage renal disease patients on hemodialysis. Int J Colorectal Dis 27, 811–816 (2012). https://doi.org/10.1007/s00384-011-1400-8

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  • DOI: https://doi.org/10.1007/s00384-011-1400-8

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