Association of anaesthesia-directed sedation with unplanned discharge to a nursing home following non-ambulatory interventional radiology and endoscopic procedures: a retrospective cohort study*

Annika Eyth, Felix Borngaesser, Osamah M. Zmily, Maíra I. Rudolph, Ling Zhang, Vilma A. Joseph, Oleg V. Evgenov, Jason Oliveira, Nicholas Kolmel, Seena Dehkharghani, Irene Osborn, Michael E. Kiyatkin, Andrew D. Racine, Peter P. Semczuk, Shweta Garg, Karuna Wongtangman, Matthias Eikermann, Ibraheem M. Karaye

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Introduction: Interventional radiology procedures and endoscopies are performed commonly worldwide, often necessitating pharmacological sedation to optimise patient comfort. It is unclear to what extent non-anaesthetists should provide procedural sedation. Methods: We studied adult patients who previously lived independently and underwent a non-ambulatory interventional radiology or gastroenterology procedure under anaesthetist-directed or non-anaesthetist-directed sedation at a large healthcare network. The primary outcomes were postprocedural adverse discharge to a nursing home and postprocedural duration of hospital stay. Results: Among 22,868 patients included, 15,168 (66.3%) and 7700 (33.7%) underwent anaesthetist-directed sedation and non-anaesthetist-directed sedation, respectively. Of all patients receiving anaesthetist-directed sedation, 9.2% experienced adverse discharge to a nursing home compared with 21.3% undergoing non-anaesthetist-directed sedation. Anaesthetist-directed sedation was associated with reduced risk of adverse discharge to a nursing home (adjusted relative risk 0.54, 95%CI 0.45–0.63, p < 0.001, adjusted risk difference -4.6%, 95%CI -5.8 to -3.4, p < 0.001) and a shorter postprocedural duration of hospital stay (median (IQR [range]) 2 (1–6 [0–315]) days vs. 5 (2–12 [0–268]) days; adjusted model estimate 0.84, 95%CI 0.79–0.89, p < 0.001). The lower risk of adverse discharge to a nursing home and shorter duration of hospital stay in patients undergoing anaesthetist-directed sedation was reproduced in an instrumental variable analysis (adjusted risk difference -4.3%, 95%CI -8.4 to -0.1, p = 0.043; and -1.41 days, 95%CI -1.43 to -1.41 days, p < 0.001, respectively). Among patients undergoing anaesthetist-directed sedation the mean (SD) proportion of missing blood pressure measurements was lower (0.7 (4.9) % vs. 8.0 (14.6) %, p < 0.001), which mediated the effect of anaesthetist-directed sedation on adverse discharge. Discussion: Among patients undergoing a non-ambulatory interventional radiology procedure or a gastrointestinal endoscopy, anaesthetist-directed sedation is associated with a reduced risk of adverse discharge to a nursing home and a shorter duration of hospital stay.

Original languageEnglish (US)
JournalAnaesthesia
DOIs
StateAccepted/In press - 2024

Keywords

  • hospital costs
  • monitored anaesthesia care
  • non-home discharge
  • postprocedural complications
  • procedural sedation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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