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PWE-056 Cancer is the Leading Cause of Hospital Death in 30 Day Mortality Audit following Endoscopy
  1. M Kasi1,
  2. S P Dunlop1
  1. 1Gastroenterology, Derriford Hospital, Plymouth NHS Trust, Plymouth, UK

Abstract

Introduction Mortality post endoscopy is a quality standard for all endoscopy units. Many of the published 30 day mortality studies relate specifically to those presenting with gastro-intestinal bleeding or following a therapeutic procedure, rather than for any indication or after any endoscopic procedure.

Methods We reviewed all hospital deaths occurring within 30 days following any endoscopic procedure in 12 months from 1 January 2011 to 31 December 2011, at Derriford Hospital. Data was available from Clinical coding by linking the endoscopy database with the death registry. All patients’ case notes were analysed and data collected including patient demographics, indications for the procedure, type of procedure, immediate post procedure complications and cause of death.

Results There were 13310 procedures performed (gastroscopy 6224; colonoscopy 4660; flexible sigmoidoscopy 1920; ERCP 348; other procedure 158). 146 patients died within 30 days of their endoscopy (all cause mortality 1.0%). Of these, 118 patients died in hospital (81%) and 28 patients died within the community (19%). 35/118 (30%) of hospital patients died within 7 days of the procedure. Cancer was the leading cause of hospital death, accounting for 35/118 (30%); GI Cancer accounted for 24/35 (69%) and Non GI Cancer 11/35 (31%). Other causes were pneumonia 22/118 (19%); upper GI bleeding 8/118 (7%); vascular complications 16/118 (14%). All deaths from upper GI bleeding occurred within 7 days and 12/16 (75%) deaths from vascular complications occurred after 7 days. 30 day all cause mortality rates for each procedure were: colonoscopy 0.7%; ERCP 2.2%; flexible sigmoidoscopy 0.9%; upper GI endoscopy 2%; others 1.6%. Two patients had perforated distal bowel after having had flexible sigmoidoscopy (procedure related death, 2/13,283; 0.015% or 1.5 in 10,000). There were no other procedure related deaths. Eight patients died on the same day of their procedure due to uncontrolled bleeding (n = 3), acute kidney injury (n = 1), multi-organ failure following ERCP for cholangitis (n = 1), respiratory failure (n = 2) and acute ischaemia of stomach (n = 1). There were no sedation related complications nor use of reversal agents.

Conclusion Deaths within 30 days following an endoscopic procedure are most likely associated with cancer or pneumonia with procedure related or associated deaths being rare. GI cancers are twice as likely to be associated than non-GI cancers.

Disclosure of Interest None Declared.

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