Anaesthesia care with and without tracheal intubation during emergency endoscopy for peptic ulcer bleeding: a population-based cohort study
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Anaesthesia care with and without tracheal intubation during emergency endoscopy for peptic ulcer bleeding : a population-based cohort study. / Lohse, N; Lundstrøm, L H; Vestergaard, T R; Risom, M; Rosenstock, S J; Foss, N B; Møller, M H.
In: British Journal of Anaesthesia, Vol. 114, No. 6, 06.2015, p. 901-8.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Anaesthesia care with and without tracheal intubation during emergency endoscopy for peptic ulcer bleeding
T2 - a population-based cohort study
AU - Lohse, N
AU - Lundstrøm, L H
AU - Vestergaard, T R
AU - Risom, M
AU - Rosenstock, S J
AU - Foss, N B
AU - Møller, M H
N1 - © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
PY - 2015/6
Y1 - 2015/6
N2 - BACKGROUND: Emergency upper gastrointestinal bleeding is a common condition with high mortality. Most patients undergo oesophagogastroduodenoscopy (OGD), but no universally agreed approach exists to the type of airway management required during the procedure. We aimed to compare anaesthesia care with tracheal intubation (TI group) and without airway instrumentation (monitored anaesthesia care, MAC group) during emergency OGD.METHODS: This was a prospective, nationwide, population-based cohort study during 2006-13. Emergency OGDs performed under anaesthesia care were included. End points were 90 day mortality (primary) and length of stay in hospital (secondary). Associations between exposure and outcomes were assessed in logistic and linear regression models, adjusted for the following potential confounders: shock at admission, level of anaesthetic expertise present, ASA score, Charlson comorbidity index score, BMI, age, sex, alcohol use, referral origin (home or in-hospital), Forrest classification, ulcer localization, and postoperative care.RESULTS: The study group comprised 3580 patients under anaesthesia care: 2101 (59%) for the TI group and 1479 (41%) for the MAC group. During the first 90 days after OGD, 18.9% in the TI group and 18.4% in the MAC group died, crude odds ratio=1.03 [95% confidence interval (CI)=0.87-1.23, P=0.701], adjusted odds ratio=0.95 (95% CI=0.79-1.15, P=0.590). Patients in the TI group stayed slightly longer in hospital [mean 8.16 (95% CI=7.63-8.60) vs 7.63 days (95%=CI 6.92-8.33), P=0.108 in adjusted analysis].CONCLUSIONS: In this large population-based cohort study, anaesthesia care with TI was not different from anaesthesia care without airway instrumentation in patients undergoing emergency OGD in terms of 90 day mortality and length of hospital stay.
AB - BACKGROUND: Emergency upper gastrointestinal bleeding is a common condition with high mortality. Most patients undergo oesophagogastroduodenoscopy (OGD), but no universally agreed approach exists to the type of airway management required during the procedure. We aimed to compare anaesthesia care with tracheal intubation (TI group) and without airway instrumentation (monitored anaesthesia care, MAC group) during emergency OGD.METHODS: This was a prospective, nationwide, population-based cohort study during 2006-13. Emergency OGDs performed under anaesthesia care were included. End points were 90 day mortality (primary) and length of stay in hospital (secondary). Associations between exposure and outcomes were assessed in logistic and linear regression models, adjusted for the following potential confounders: shock at admission, level of anaesthetic expertise present, ASA score, Charlson comorbidity index score, BMI, age, sex, alcohol use, referral origin (home or in-hospital), Forrest classification, ulcer localization, and postoperative care.RESULTS: The study group comprised 3580 patients under anaesthesia care: 2101 (59%) for the TI group and 1479 (41%) for the MAC group. During the first 90 days after OGD, 18.9% in the TI group and 18.4% in the MAC group died, crude odds ratio=1.03 [95% confidence interval (CI)=0.87-1.23, P=0.701], adjusted odds ratio=0.95 (95% CI=0.79-1.15, P=0.590). Patients in the TI group stayed slightly longer in hospital [mean 8.16 (95% CI=7.63-8.60) vs 7.63 days (95%=CI 6.92-8.33), P=0.108 in adjusted analysis].CONCLUSIONS: In this large population-based cohort study, anaesthesia care with TI was not different from anaesthesia care without airway instrumentation in patients undergoing emergency OGD in terms of 90 day mortality and length of hospital stay.
KW - Aged
KW - Aged, 80 and over
KW - Anesthesia
KW - Cohort Studies
KW - Databases, Factual
KW - Denmark
KW - Emergency Medical Services
KW - Endoscopy, Digestive System
KW - Endpoint Determination
KW - Female
KW - Hospital Mortality
KW - Humans
KW - Intubation, Intratracheal
KW - Longevity
KW - Male
KW - Middle Aged
KW - Peptic Ulcer Hemorrhage
KW - Population
KW - Postoperative Care
KW - Prospective Studies
KW - Registries
U2 - 10.1093/bja/aev100
DO - 10.1093/bja/aev100
M3 - Journal article
C2 - 25935841
VL - 114
SP - 901
EP - 908
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
SN - 0007-0912
IS - 6
ER -
ID: 160055798