COLONOSCOPY COMPLICATIONS IN THE ELDERLY: the impact of age and multimorbidity

Abstract

Context Age has been considered an independent risk factor for colonoscopy complications, especially when associated with multimorbidity. Objectives The primary objective was to verify the relationships between age, multimorbidity and colonoscopy complications in the elderly. Methods A retrospective cohort including patients of 60 years or older who had undergone a colonoscopy. Data relating to age, multimorbidities according to the cumulative illness scale for geriatrics and the Charlson index and complications related to bowel preparation and procedure (sedation and exam) were collected. Results Of the 207 patients (mean age 70.47 ± 7.04) with appropriate indication for colonoscopy according to the American Society for Gastrointestinal Endoscopy, 43 (20.77%) patients had some colonoscopy complications: 1 (0.48%) with the sedation (apnea), 4 (1.93%) with the procedure (abdominal pain and bacteremia) and 38 (18.35%) with the bowel preparation (acute renal failure, hypotension). Individuals ≥80 years had an RR = 3.4 (1.2-10.1), P = 0.025, and those with a Charlson index 3 had an RR = 5.2 (1.6-16.8), P = 0.006, for complications. The cumulative illness rating scale for geriatrics was not associated with complications (P = 0.45). Conclusion There was a significant risk of complications in ≥80 years and in the group with a Charlson index 3. The cumulative illness rating scale for geriatrics was not a good predictor of risk in this sample.

Contexto A idade tem sido considerada um fator de risco independente para complicações colonoscópicas, especialmente na presença de multimorbidade. Objetivos O objetivo primário foi verificar a correlação entre idade, multimorbidade e complicações colonoscópicas em idosos. Métodos Coorte retrospectiva de pacientes com 60 anos ou mais submetidos a colonoscopia. Foram coletados idade, multimorbidade (de acordo com os índices cumulative illness scale for geriatrics e Charlson) e complicações relacionadas ao preparo e procedimento (sedação e exame). Resultado Dos 207 pacientes (idade média 70.47 ± 7.04) com indicação apropriada para colonoscopia segundo a Sociedade Americana de Endoscopia Gastrointestinal, 43 (20.77%) tiveram alguma complicação: 1 (0.48%) com complicação pela sedação (apneia), 4 (1.93%) relacionada ao procedimento (dor abdominal e bacteremia) e 38 (18.35%) pelo preparo (insuficiência renal aguda, hipotensão). Pacientes ≥80 anos tiveram RR = 3.4 (1.2-10.1), P = 0.025, para complicações e aqueles com índice de Charlson 3, um RR = 5.2 (1.6-16.8), P = 0.006. Cumulative illness rating scale for geriatrics, não mostrou associação com complicações (P = 0.45). Conclusão Houve risco significativo de complicação em muito idosos (≥80 years) e no grupo com índice de Charlson 3. Cumulative illness rating scale for geriatrics não se mostrou um bom preditor de risco nesta amostra.