Introduction Colonoscopy in patients aged over 80 can be a high risk procedure due to increased comorbidity and risk of procedural complications. This audit was carried out to ensure that colonoscopies were being performed appropriately, with respect to the indication, in accordance with BSG guidance; with the aim of improving safety and appropriateness of procedure for this sensitive group of patients.
Methods We retrospectively reviewed 158 colonoscopies over a 16-month period in patients over the age of 80. Data were collected from medical records, the Endoscopy Reporting System, referral letters and the Pathology system. Audit measures included the indications for colonoscopy, comorbidity, outcome, completion rate and complications such as; renal impairment due to bowel preparation, readmissions within 8 days from the procedure and mortality within 30 days.
Results 6.33% (10/158) of colonoscopies were carried out inappropriately in relation to the indication. Inappropriate indications included normocytic anaemia, abdominal pain, weight loss, short history (<6 weeks) of a change in bowel habit. The rate of inappropriate colonoscopy in relation to co morbidity was 5.06% (5/158). Significant co-morbidities included triple vessel disease and ongoing angina, recent myocardial infarction, symptomatic heart failure, pulmonary embolism and previous stroke. The rate of inappropriate colonoscopy with respect to outcome was 5.7% (9/158) due to a combination of inappropriate indication and high risk procedure with normal findings. 18% (29/158) of colonoscopies were incomplete due to; severe diverticulosis, obstructive malignancy, adhesions, excess looping, high risk of perforation and instrument inadequacy. Renal impairment (serum creatinine rise ≥1.5-fold from the reference value within 8 days) was identified in 1 case due to bowel preparation. Of note, only 29.1% (46/158) of patients had their creatinine measured within a month prior to and following the procedure. The 8-day post procedure readmission rate was 2.35% (4/158). Three of the readmissions were directly related to the colonoscopy. The mortality rate within 30 days was 0%. 28% (45/158) of procedures were carried out via the fast track referral pathway; of these nine cases were diagnosed with malignancy (20%), 9 were found to be normal (20%), 18 had diverticulosis (40%), 8 had polyps (18%), 2 had colitis (4%) and 1 had angiodysplasia (2%).
Conclusion Colonoscopy can be a high risk procedure in patients over the age of 80. Patients should be selected carefully to ensure that the benefits from the procedure outweigh the risks. The need for colonoscopy should be questioned in elderly patients in whom colonoscopy findings will not significantly affect management and for such patients alternative methods of imaging may be more appropriate.
Competing interests None declared.
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