Cardiovascular complications after GI endoscopy: occurrence and risks in a large hospital system.

BACKGROUND: There is limited information concerning the risks for, and occurrence of, cardiovascular complications because of GI endoscopy. Published data are based on questionnaire surveys, which have a potential for bias. Moreover, available studies pertain exclusively to out-patients. METHODS: In-patients and day-stay patients who incurred charges for endoscopy with endoscopic procedure coding from 1999 through 2001 were identified from a financial database for all 9 hospitals in a large health care system. From these patients, those considered "at risk" for cardiovascular complications were selected based on charges for cardioactive medications, cardiac enzyme determinations, or intensive care services on the day of or the day after endoscopy. Medical records were reviewed for 25% of these patients, selected at random, noting demographics, history, and a modified Goldman score in patients with cardiovascular complications (defined as arrhythmia, chest pain or anginal equivalent, hypotension or myocardial infarction occurring within 24 hours after endoscopy). Identical information was obtained from a random sample of 0.5% of the chart records for all patients undergoing endoscopy. RESULTS: Patients who underwent endoscopy were not reliably identified for one hospital. This hospital was omitted from the calculation of the extrapolated rate of complication occurrence, but patients identified through chart review as having or not having a complication after endoscopy were included in the risk analysis. The extrapolated rate of occurrence of cardiovascular complications was 308: 95% CI [197, 457] per 100,000 procedures. Independent risk factors were: male gender, modified Goldman score, and use of propofol. CONCLUSIONS: In this study of patients undergoing hospital-based GI endoscopy, the risk of procedure-related cardiovascular complications was 2 to 70 times higher than previously reported. This finding may be ascribed to differences in the populations sampled and to a case-finding method that minimized reporting and ascertainment biases.

Can computerized cost data substitute for chart review?

Identification of alternatives to manual chart review might improve efficiency in quality improvement work. This study at a large community teaching hospital in central New Jersey considered whether selected charges from a patient-level costs database could identify compliance with Sixth Scope of Work indicators in congestive heart failure (CHF). Charges resulting from specific tests, from test outcomes, and from prescribed treatments were identified from among 75 randomly chosen patients with CHF. In the sample 65% (as determined by database analysis) and 69% (as determined by chart review) complied with the principal peer review organization criterion. This difference was less than that found between review and re-review of study charts.