Upper gastrointestinal endoscopy procedure volume trends, perioperative mortality, and malpractice claims: Population-based analysis

Nelli Nurminen; Tommi Järvinen; Eric Robinson; Nanruoyi Zhou; Silja Salo; Jari Räsänen; Ville Kytö; Ilkka Ilonen

doi:10.1055/a-2265-8757

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(03): E385-E393
DOI: 10.1055/a-2265-8757

Original article

Upper gastrointestinal endoscopy procedure volume trends, perioperative mortality, and malpractice claims: Population-based analysis

Nelli Nurminen

¹Department of General Thoracic and Esophageal surgery, Heart and Lung Center, HUS Helsingin yliopistollisen sairaala, Helsinki, Finland (Ringgold ID: RIN3836)

,

Tommi Järvinen

¹Department of General Thoracic and Esophageal surgery, Heart and Lung Center, HUS Helsingin yliopistollisen sairaala, Helsinki, Finland (Ringgold ID: RIN3836)

,

Eric Robinson

²Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, United States (Ringgold ID: RIN5925)

,

Nanruoyi Zhou

³Department of Surgery, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States (Ringgold ID: RIN159947)

,

Silja Salo

⁴Department of Gastrointestinal Surgery, Abdominal Center, Helsinki University Central Hospital, Helsinki, Finland (Ringgold ID: RIN159841)

,

Jari Räsänen

¹Department of General Thoracic and Esophageal surgery, Heart and Lung Center, HUS Helsingin yliopistollisen sairaala, Helsinki, Finland (Ringgold ID: RIN3836)

,

Ville Kytö

⁵Heart Center, TYKS Turku University Hospital, Turku, Finland (Ringgold ID: RIN60652)

⁶Clinical Research Center, TYKS Turku University Hospital, Turku, Finland (Ringgold ID: RIN60652)

⁷Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (Ringgold ID: RIN8058)

,

Ilkka Ilonen

¹Department of General Thoracic and Esophageal surgery, Heart and Lung Center, HUS Helsingin yliopistollisen sairaala, Helsinki, Finland (Ringgold ID: RIN3836)

› Author Affiliations

Abstract

Background and study aims Upper gastrointestinal endoscopy (EGD) is one of the most common diagnostic procedures done to examine the foregut, but it can also be used for therapeutic interventions. The main objectives of this study were to investigate trends in EGD utilization and mortality related to it in a national low-threshold healthcare system, assess perioperative safety, and identify and describe patient-reported malpractice claims from the national database.

Patients and methods We retrospectively identified patients from the Finnish Patient Care Registry who underwent diagnostic or procedural EGD between 2010 and 2018. In addition, patient-reported claims for malpractice were analyzed from the National Patient Insurance Center (PIC) database. Patient survival data were gathered collectively from the National Death Registry from Statistics Finland.

Results During the study period, 409,153 EGDs were performed in Finland for 298,082 patients, with an annual rate of 9.30 procedures per 1,000 inhabitants, with an annual increase of 2.6%. Thirty-day all-cause mortality was 1.70% and 90-day mortality was 3.84%. For every 1,000 patients treated, 0.23 malpractice claims were filed.

Conclusions The annual rate of EGD increased by 2.6% during the study, while the rate of interventional procedures remained constant. Also, while the 30-day mortality rate declined over the study period, it is an unsuitable quality metric for EGDs in comprehensive centers because a patient’s underlying disease plays a larger role than the procedure in perioperative mortality. Finally, there were few malpractice claims, with self-evident causes prevailing.

Full Text

References

References
1 Peery AF, Crockett SD, Murphy CC. et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021. Gastroenterology 2022; 162: 621-644
2 Srivathsan R, Paul B, Tim S. et al. National census of UK endoscopy services in 2019. Frontline Gastroenterology 2021; 12: 451
3 Reed WP, Kilkenny JW, Dias CE. et al. A prospective analysis of 3525 esophagogastroduodenoscopies performed by surgeons. Surg Endosc 2004; 18: 11-21
4 Quine MA, Bell GD, McCloy RF. et al. Prospective audit of perforation rates following upper gastrointestinal endoscopy in two regions of England. Br J Surg 1995; 82: 530-533
5 Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: A survey among German gastroenterologists. Gastrointest Endosc 2001; 53: 620-627
6 Wolfsen HC, Hemminger LL, Achem SR. et al. Complications of endoscopy of the upper gastrointestinal tract: a single-center experience. Mayo Clin Proc 2004; 79: 1264-1267
7 Silvis SE, Nebel O, Rogers G. et al. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA 1976; 235: 928-930
8 Sharma VK, Nguyen CC, Crowell MD. et al. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc 2007; 66: 27-34
9 Goudra B, Nuzat A, Singh PM. et al. Association between type of sedation and the adverse events associated with gastrointestinal endoscopy: An analysis of 5 years' data from a tertiary center in the USA. Clin Endosc 2017; 50: 161-169
10 Vallurupalli S, Manchanda S. Risk of acquired methemoglobinemia with different topical anesthetics during endoscopic procedures. Local Reg Anesth 2011; 4: 25-28
11 Chirica M, Champault A, Dray X. et al. Esophageal perforations. J Visc Surg 2010; 147: e117-e128
12 Brinster CJ, Singhal S, Lee L. et al. Evolving options in the management of esophageal perforation. Ann Thorac Surg 2004; 77: 1475-1483
13 Bush N, Bhattacharjee S, Sachan A. et al. Perforations from endoscopic dilation of corrosive strictures in adults: A systematic review and meta-analysis. Dig Dis Sci 2022; 67: 3200-3209
14 Josino IR, Madruga-Neto AC, Ribeiro IB. et al. Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: Systematic review and meta-analysis. Gastroenterol Res Pract 2018; 2018: 5874870
15 Qumseya BJ, Wani S, Desai M. et al. Adverse events after radiofrequency ablation in patients with barrett’s esophagus: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 1086-1095.e1086
16 Dan X, Lv XH, San ZJ. et al. Efficacy and safety of multiband mucosectomy versus cap-assisted endoscopic resection for early esophageal cancer and precancerous lesions: A systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 2019; 29: 313-320
17 Facciorusso A, Antonino M, Di Maso M. et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis. World J Gastrointest Endosc 2014; 6: 555-563
18 Libânio D, Costa MN, Pimentel-Nunes P. et al. Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis. Gastrointest Endosc 2016; 84: 572-586
19 Yoo JH, Shin SJ, Lee KM. et al. Risk factors for perforations associated with endoscopic submucosal dissection in gastric lesions: emphasis on perforation type. Surg Endosc 2012; 26: 2456-2464
20 Sdralis EIK, Petousis S, Rashid F. et al. Epidemiology, diagnosis, and management of esophageal perforations: systematic review. Dis Esophagus 2017; 30: 1-6
21 Merchea A, Cullinane DC, Sawyer MD. et al. Esophagogastroduodenoscopy-associated gastrointestinal perforations: A single-center experience. Surgery 2010; 148: 876-882
22 Kohli DR, Kennedy KF, Desai M. et al. Comparative safety of endoscopic vs radiological gastrostomy tube placement: outcomes from a large, nationwide Veterans Affairs database. Am J Gastroenterol 2021; 116: 2367-2373
23 Schneider AS, Schettler A, Markowski A. et al. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent. Scand J Gastroenterol 2014; 49: 891-898
24 Nelson DB. Infectious disease complications of GI endoscopy: part II, exogenous infections. Gastrointest Endosc 2003; 57: 695-711
25 Nelson DB. Infectious disease complications of GI endoscopy: Part I, endogenous infections. Gastrointest Endosc 2003; 57: 546-556
26 Botoman VA, Surawicz CM. Bacteremia with gastrointestinal endoscopic procedures. Gastrointest Endosc 1986; 32: 342-346
27 Deb A, Perisetti A, Goyal H. et al. Gastrointestinal endoscopy-associated infections: Update on an emerging issue. Dig Dis Sci 2022; 67: 1718-1732
28 Kovaleva J. Infectious complications in gastrointestinal endoscopy and their prevention. Best Pract Res Clin Gastroenterol 2016; 30: 689-704
29 Chadwick G, Groene O, Hoare J. et al. A population-based, retrospective, cohort study of esophageal cancer missed at endoscopy. Endoscopy 2014; 46: 553-560
30 Raftopoulos SC, Segarajasingam DS, Burke V. et al. A cohort study of missed and new cancers after esophagogastroduodenoscopy. Am J Gastroenterol 2010; 105: 1292-1297
31 Ben-Menachem T, Decker GA, Early DS. et al. Adverse events of upper GI endoscopy. Gastrointest Endosc 2012; 76: 707-718
32 Lee TJ, Siau K, Esmaily S. et al. Development of a national automated endoscopy database: The United Kingdom National Endoscopy Database (NED). United European Gastroenterol J 2019; 7: 798-806
33 Sandelin H, Waris E, Hirvensalo E. et al. Patient injury claims involving fractures of the distal radius. Acta Orthop 2018; 89: 240-245
34 Laukkavirta M, Blomgren K, Väärämäki S. et al. Compensated patient injuries in the treatment of abdominal aortic and iliac artery aneurysms in finland: A nationwide patient insurance registry study. Ann Vasc Surg 2022; 80: 283-292
35 Welling M, Takala A. Patterns of malpractice claims and compensation after surgical procedures: a retrospective analysis of 8,901 claims from the Finnish patient insurance registry. Patient Saf Surg 2023; 17: 3
36 Clavien PA, Vetter D, Staiger RD. et al. The Comprehensive Complication Index (CCI®): Added value and clinical perspectives 3 years "down the line". Ann Surg 2017; 265: 1045-1050
37 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213
38 Prami T, Khanfir H, Deleskog A. et al. Clinical factors associated with initiation of and persistence with ADP receptor-inhibiting oral antiplatelet treatment after acute coronary syndrome: a nationwide cohort study from Finland. BMJ Open 2016; 6: e012604
39 Sund R. Quality of the Finnish Hospital Discharge Register: A systematic review. Scand J Public Health 2012; 40: 505-515
40 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383
41 Kerola AM, Palomäki A, Rautava P. et al. Less revascularization in young women but impaired long-term outcomes in young men after myocardial infarction. Eur J Prev Cardiol 2022; 29: 1437-1445
42 Chatelanat O, Spahr L, Bichard P. et al. Evaluation of 30-day mortality in patients undergoing gastrointestinal endoscopy in a tertiary hospital: a 3-year retrospective survey. BMJ Open Gastroenterol 2022; 9: e000977
43 Eisen GM, Baron TH, Dominitz JA. et al. Complications of upper GI endoscopy. Gastrointest Endosc 2002; 55: 784-793
44 Teh JL, Shabbir A, Yuen S. et al. Recent advances in diagnostic upper endoscopy. World journal of gastroenterology 2020; 26: 433-447
45 Acosta CJ, Goldberg D, Amin S. Evaluating the impact of frailty on periprocedural adverse events and mortality among patients with GI bleeding. Gastrointest Endosc 2021; 94: 517-525.e511
46 Paspatis GA, Arvanitakis M, Dumonceau JM. et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement - Update 2020. Endoscopy 2020; 52: 792-810
47 Maiti S, Congly SE, Ma C. et al. Causes and outcomes of medicolegal proceedings following gastrointestinal endoscopy in Canada. Gastro Hep Advances 2023; 2: 163-169
48 Hiyama T, Yoshihara M, Tanaka S. et al. Trend in Japanese malpractice litigation involving gastrointestinal endoscopy. Am J Gastroenterol 2009; 104: 251-252
49 Hernandez LV, Klyve D, Regenbogen SE. Malpractice claims for endoscopy. World J Gastrointest Endosc 2013; 5: 169-173