Original articleClinical endoscopyRisk of perforation from a colonoscopy in adults: a large population-based study
Section snippets
Database
The present study is based on longitudinal data derived from Medi-Cal, the Medicaid program for the state of California.46 The Medi-Cal program serves more than 6.5 million beneficiaries, of whom approximately 3.1 million (48%) are in the Fee-For-Service (FFS) system, whereas the remainder are enrolled in managed care plans.47 In 1994, 86% of the Medi-Cal beneficiaries received their care via the FFS program; this decreased to just over 50% in 2001 and has continued at that level thereafter.47,
Perforation rate and analysis of risk compared with general population controls
A total of 277,434 individuals (exposed cohort) met the 7-day continuous eligibility criterion (after excluding 241 patients who did not). The corresponding number in the control cohort was 1,072,723. The mean (SD) age was comparable in the exposed and control cohorts, at 64.20 ± 14.80 years (range 18-107.8 years) and 63.97 ± 14.99 years (range 18-107.9 years), respectively. Among the respective demographic groups (Table 3), women, people aged 65 to 80 years, and whites accounted for the
Discussion
Recent large studies showed perforation rates between 0.016% and 0.090%, depending on the center and the data source. Of note, 3 studies found perforation rates outside of this range. By using a mailed questionnaire, Sieg et al,36 prospectively evaluated 82,416 colonoscopies and found a low incidence of 0.005%. This could likely be explained by a selection bias because the physicians' self reported the perforations; also, only those perforations that required a surgical intervention were
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DISCLOSURE: The following author disclosed financial relationships relevent to this publication: G. Triadafilopoulos: Equity position with Avantis Medical. All other authors disclosed no financial relationships relevent to this publication. This study was funded by Institute of Clinical Outcomes Research and Education, which did not play any role in the study design or conduct, analysis, or interpretation of data, or in the writing or approval of the manuscript.
Presented at Digestive Disease Week, May 19-24, 2007, Washington DC (Gastrointest Endosc 2007;65:AB320).
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