Abstract：
OBJECTIVE: Currently, no standard approach exists to the level of monitoring or presence of staff with anaesthetic expertise required during emergency esophago-gastro-duodenoscopy (EGD) for peptic ulcer bleeding (PUB). We assess the association between anaesthesia care and mortality. We further describe the prevalence and inter-hospital variation of anaesthesia care in Denmark and identify clinical predictors for choosing anaesthesia care.
METHODS: This population-based cohort study included all emergency EGDs for PUB in adults during 2012-2013. About 90-day all-cause mortality after EGD was estimated by crude and adjusted logistic regression. Clinical predictors of anaesthesia care were identified in another logistic regression model.
RESULTS: Some 3.056 EGDs performed at 21 hospitals were included; 2074 (68%) received anaesthesia care and 982 (32%) were managed under supervison of the endoscopist. Some 16.7% of the patients undergoing EGD with anaesthesia care died within 90 days after the procedure, compared to 9.8% of the patients who had no anaesthesia care, adjusted OR = 1.51 (95% CI = 1.25-1.83). Comparing the two hospitals with the most frequent (98.6% of al EGDs) and least frequent (6.9%) use of anaesthesia care, mortality was 13.7% and 11.7%, respectively, adjusted OR = 1.22 (95% CI = 0.55-2.71). The prevalence of anaesthesia care varied between the hospitals, median = 78.9% (range 6.9-98.6%). Predictors of choosing anaesthesia care were shock at admission, high ASA score, and no pre-existing comorbidity.
CONCLUSIONS: Use of anaesthesia care for emergency EGD was associated with increased mortality, most likely because of confounding by indication. The use of anaesthesia care varied greatly between hospitals, but was unrelated to mortality at hospital level.
METHODS: This population-based cohort study included all emergency EGDs for PUB in adults during 2012-2013. About 90-day all-cause mortality after EGD was estimated by crude and adjusted logistic regression. Clinical predictors of anaesthesia care were identified in another logistic regression model.
RESULTS: Some 3.056 EGDs performed at 21 hospitals were included; 2074 (68%) received anaesthesia care and 982 (32%) were managed under supervison of the endoscopist. Some 16.7% of the patients undergoing EGD with anaesthesia care died within 90 days after the procedure, compared to 9.8% of the patients who had no anaesthesia care, adjusted OR = 1.51 (95% CI = 1.25-1.83). Comparing the two hospitals with the most frequent (98.6% of al EGDs) and least frequent (6.9%) use of anaesthesia care, mortality was 13.7% and 11.7%, respectively, adjusted OR = 1.22 (95% CI = 0.55-2.71). The prevalence of anaesthesia care varied between the hospitals, median = 78.9% (range 6.9-98.6%). Predictors of choosing anaesthesia care were shock at admission, high ASA score, and no pre-existing comorbidity.
CONCLUSIONS: Use of anaesthesia care for emergency EGD was associated with increased mortality, most likely because of confounding by indication. The use of anaesthesia care varied greatly between hospitals, but was unrelated to mortality at hospital level.
摘要：
目标：目前，对于消化性溃疡出血(PUB)的急诊食道-胃-十二指肠镜检查(EGD)期间所需的具有麻醉专业知识的工作人员的监测水平或在场没有标准方法.我们评估麻醉护理与死亡率之间的关联。我们进一步描述了丹麦麻醉护理的患病率和医院间差异，并确定了选择麻醉护理的临床预测因素。
方法：这项基于人群的队列研究纳入了2012-2013年成人PUB的所有紧急EGD。EGD后约90天全因死亡率通过粗和调整逻辑回归估计。在另一个逻辑回归模型中确定了麻醉护理的临床预测因子。
结果：包括在21家医院进行的3.056个EGD；2074（68％）接受了麻醉护理，982（32％）在内窥镜医师的监督下进行了管理。接受EGD麻醉护理的患者中，约16.7%在手术后90天内死亡。与9.8%没有麻醉护理的患者相比，校正OR=1.51（95%CI=1.25-1.83）。比较两家医院使用麻醉护理最频繁(98.6%)和最少(6.9%)的情况，死亡率分别为13.7%和11.7%,分别,校正OR=1.22（95%CI=0.55-2.71）。各医院之间麻醉护理的普及程度不同,中位数=78.9%（范围6.9-98.6%）。选择麻醉护理的预测因素是入院时的休克，ASA得分高,没有预先存在的合并症。
结论：在急诊EGD中使用麻醉护理与死亡率增加相关，很可能是因为指征混淆了。医院之间麻醉护理的使用差异很大，但与医院死亡率无关.
方法：这项基于人群的队列研究纳入了2012-2013年成人PUB的所有紧急EGD。EGD后约90天全因死亡率通过粗和调整逻辑回归估计。在另一个逻辑回归模型中确定了麻醉护理的临床预测因子。
结果：包括在21家医院进行的3.056个EGD；2074（68％）接受了麻醉护理，982（32％）在内窥镜医师的监督下进行了管理。接受EGD麻醉护理的患者中，约16.7%在手术后90天内死亡。与9.8%没有麻醉护理的患者相比，校正OR=1.51（95%CI=1.25-1.83）。比较两家医院使用麻醉护理最频繁(98.6%)和最少(6.9%)的情况，死亡率分别为13.7%和11.7%,分别,校正OR=1.22（95%CI=0.55-2.71）。各医院之间麻醉护理的普及程度不同,中位数=78.9%（范围6.9-98.6%）。选择麻醉护理的预测因素是入院时的休克，ASA得分高,没有预先存在的合并症。
结论：在急诊EGD中使用麻醉护理与死亡率增加相关，很可能是因为指征混淆了。医院之间麻醉护理的使用差异很大，但与医院死亡率无关.
