背景和目的:结肠镜检查是胃肠病学的关键诊断和治疗程序。然而,它有风险,包括低氧血症,会影响患者安全。了解导致严重低氧血症发生率的因素,特别是程序持续时间的作用,对于改善患者预后至关重要。这项研究旨在阐明结肠镜检查程序的长度与严重低氧血症发生之间的关系。方法:我们在舍巴医疗中心进行了一项回顾性队列研究,以色列,包括从2020年1月至2024年1月接受结肠镜检查的21,524名成年患者。这项研究的重点是严重低氧血症的发生率,定义为氧饱和度下降到90%以下。镇静协议,涉及芬太尼的组合,咪达唑仑,和异丙酚根据内镜医师的判断进行个性化。数据是从电子健康记录中收集的,涵盖患者人口统计学,临床评分,镇静和程序细节,和结果。统计分析,包括逻辑回归,用于检查手术持续时间和低氧血症之间的关系,适应各种患者和程序因素。结果:我们最初收集了26,569例接受结肠镜检查的患者的记录,由于数据不完整,不包括5045,最终导致21,524名患者。20分钟以下的程序占总数的48.9%,而那些持续20-40分钟的占50.7%。只有8.5%持续了40-60分钟,2.9%超过60分钟。更长的手术与更高的低氧血症风险相关:17.3%<20分钟,24.2%,20-40分钟,32.4%,持续40-60分钟,≥60分钟时为36.1%。60-80岁和≥80岁的患者低氧血症几率增加(分别为aOR1.1,95%CI1.0-1.2和aOR1.2,95%CI1.0-1.4)。手术持续时间为20-40分钟,40-60分钟,超过60分钟的AOR为1.5(95%CI1.4-1.6),2.1(95%CI1.9-2.4),和2.4(95%CI2.0-3.0),分别。结论:结肠镜检查的持续时间显著影响严重低氧血症的风险,持续时间较长,风险较高。这项研究强调了优化程序效率和根据个体患者风险状况定制镇静方案以提高结肠镜检查安全性的重要性。需要进一步的研究来制定策略,以在不影响护理质量的情况下最大限度地减少手术时间。从而降低低氧血症的风险并提高患者的安全性。
Background and Aims: Colonoscopy is a critical diagnostic and therapeutic procedure in gastroenterology. However, it carries risks, including hypoxemia, which can impact patient safety. Understanding the factors that contribute to the incidence of severe hypoxemia, specifically the role of procedure
duration, is essential for improving patient outcomes. This study aims to elucidate the relationship between the length of colonoscopy procedures and the occurrence of severe hypoxemia. Methods: We conducted a retrospective cohort study at Sheba Medical Center, Israel, including 21,524 adult patients who underwent colonoscopy from January 2020 to January 2024. The study focused on the incidence of severe hypoxemia, defined as a drop in oxygen saturation below 90%. Sedation protocols, involving a combination of Fentanyl, Midazolam, and Propofol were personalized based on the endoscopist\'s discretion. Data were collected from electronic health records, covering patient demographics, clinical scores, sedation and procedure details, and outcomes. Statistical analyses, including logistic regression, were used to examine the association between procedure
duration and hypoxemia, adjusting for various patient and procedural factors. Results: We initially collected records of 26,569 patients who underwent colonoscopy, excluding 5045 due to incomplete data, resulting in a final cohort of 21,524 patients. Procedures under 20 min comprised 48.9% of the total, while those lasting 20-40 min made up 50.7%. Only 8.5% lasted 40-60 min, and 2.9% exceeded 60 min. Longer procedures correlated with higher hypoxemia risk: 17.3% for <20 min, 24.2% for 20-40 min, 32.4% for 40-60 min, and 36.1% for ≥60 min. Patients aged 60-80 and ≥80 had increased hypoxemia odds (aOR 1.1, 95% CI 1.0-1.2 and aOR 1.2, 95% CI 1.0-1.4, respectively). Procedure durations of 20-40 min, 40-60 min, and over 60 min had aORs of 1.5 (95% CI 1.4-1.6), 2.1 (95% CI 1.9-2.4), and 2.4 (95% CI 2.0-3.0), respectively. Conclusions: The
duration of colonoscopy procedures significantly impacts the risk of severe hypoxemia, with longer durations associated with higher risks. This study underscores the importance of optimizing procedural efficiency and tailoring sedation protocols to individual patient risk profiles to enhance the safety of colonoscopy. Further research is needed to develop strategies that minimize procedure
duration without compromising the quality of care, thereby reducing the risk of hypoxemia and improving patient safety.