Heart, kidney, or liver disease, as well as obesity and smoking, increase risk

While colonoscopies save lives by helping to detect colorectal cancer at its earliest stages, clinicians should weigh the risk of post-colonoscopy complications among persons age 75 or older, especially if they have comorbidities.

Comparing post-colonoscopy complications between those 75 and older and those age 50-74, Natalia Causada-Calo, MD, MSc, from the Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Ontario, Canada, and colleagues found that the older patients had two-times the risk for complications after screening than their younger counterparts.

“Independent risk factors for post-colonoscopy complications were the presence of anemia, cardiac arrhythmia, heart failure, hypertension, chronic kidney disease, smoking history, liver disease, and obesity,” Causada-Calo and colleagues reported in JAMA Network Open. “A greater number of previous colonoscopies was associated with a reduced risk of post-colonoscopy complications, and the cumulative incidence of surgically treated colorectal cancer was considerably lower compared with that of post-colonoscopy complications.”

The study authors added that the risk for complications appeared to increase with age, “particularly in individuals older than 75 years, with a more pronounced increase after the age of 80 years when we analyzed the rate of complications according to age divided in 5-year intervals (and after the ages of 76-78 years when considering age as a continuous variable).”

They also noted that “cardiovascular comorbidities were independently associated with post-colonoscopy complications and that, in comparison with younger individuals, those older than 75 years had an almost 4-fold increased incidence of cardiovascular complications (0.5% versus 1.8%).” This finding underscored study results by Sharma et al, which showed that people age 60 or older undergoing colonoscopies had an 80% higher risk of postprocedure pulmonary and cardiovascular complications.

In their population-based retrospective cohort study, Causada-Calo and colleagues culled data from a sample of 38,069 patients listed in Ontario administrative databases, and these patients were divided into two groups: a group of patients who were colorectal-screening-eligible (age 50-74) and an older cohort of patients age 75 years and older. The main outcome was post-colonoscopy complications, which they defined as a composite of hospitalization or ED visits within 30 days of colonoscopy. Incidence of surgically treated colorectal cancer and all-cause 30-day mortality were secondary outcomes.

Among their findings:

  • Overall, 1,310 (3.4%) experienced post-colonoscopy complications.
  • In patients older than 75, 515 of 7,627 (6.8%) had complications compared with the younger screening-eligible cohort — 795 of 30,443 patients (2.6%) (P < .001).

Independent risk factors for complications included:

  • Age, 75 or older (odds ratio [OR], 2.3; 95%CI, 2.0-2.6).
  • Anemia (OR, 1.4; 95%CI, 1.2-1.7).
  • Cardiac arrhythmia (OR, 1.7; 95%CI, 1.2-2.2).
  • Congestive heart failure (OR, 3.4; 95% CI, 2.5-4.6).
  • Hypertension (OR, 1.2; 95%CI, 1.0-1.5).
  • Chronic kidney disease (OR, 1.8; 95%CI, 1.1-3.0).
  • Liver disease (OR, 4.7; 95%CI, 3.5-6.5).
  • Smoking history (OR, 3.2; 95%CI, 2.4-4.3).
  • Obesity (OR,2.3; 95%CI, 1.2-4.2).

“The number of previous colonoscopies was associated with a lower risk of complications (OR, 0.9; 95%CI, 0.7-1.0),” the study authors reported, noting that “The incidence of surgically treated colorectal cancer was higher in the older cohort than the screening-eligible cohort (119 patients [1.6%] versus 144 patients [0.5%]; P < .001).”

All-cause mortality rates were 0.1% overall (39 patients): 0.1% (19 patients) for individuals ages 50-74 and o.2% (20 patients) for those ages ≥75 (P<.001).

The mean age among individuals included in the study was 65.2 years, 50% were women, and most (73.1%) underwent their first colonoscopy.

Limitations of the study included its observational design and the fact that the researchers could not capture all patients who had a diagnosis of colorectal cancer, only those who had surgery within 30 days of colonoscopic diagnosis.

Given these findings, Causada-Calo and colleagues noted that “the decision to perform colonoscopy should be considered carefully in older patients, particularly in the presence of comorbidities.”

  1. Clinicians should weigh the risk of post-colonoscopy complications in persons age 75 or older, especially if they have comorbidities.

  2. Be aware that independent risk factors for post-colonoscopy complications were the presence of anemia, cardiac arrhythmia, heart failure, hypertension, chronic kidney disease, smoking history, liver disease, and obesity.

Candace Hoffmann, Managing Editor, BreakingMED™

Causada-Calo disclosed no relevant relationships.

Cat ID: 16

Topic ID: 77,16,282,494,730,16,23,255,925