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