Incidence of serious complications following screening colonoscopy in adults aged 76 to 85 years old.

Abstract

Background: Screening colonoscopy harms data are limited for adults ages 76-85 years.

Methods: We conducted a retrospective cohort study of screening colonoscopies vs. fecal immunochemical tests (FIT) and general population matched comparators aged 76-85 within 3 integrated healthcare systems (2010-2019). The primary outcome was death or overnight hospitalization within 30 days. A secondary outcome also included nine harms diagnoses. Adjusted risk estimates and risk differences (RD) were obtained using Poisson regression. Narrow analyses excluded outcomes after the next lower endoscopy or colorectal procedure while broad analyses included them.

Results: Patients undergoing screening colonoscopy (N=4435) had a higher 10-day cumulative incidence of gastrointestinal bleeding (0.18% [95% CI: 0.09%, 0.35%]) and perforation (0.09% [95% CI: 0.03%, 0.23%]) than FIT (N=17,740) and the general population (N=44,350) in the narrow analysis. Screening colonoscopy patients had a 1.04% (95% CI: 0.74%, 1.34%) risk of death or hospitalization within 30 days in the narrow analysis, similar to FIT (RD = 0% [95% CI: -0.36%, 0.35%]) and the general population (RD=-0.07% [95% CI: -0.39%, 0.25%]). In the broad analysis, risk following colonoscopy was 2.30% (95% CI: 1.85%, 2.75%) with RD=1.13% (95% CI: 0.67%, 1.60%) vs. general population (age 76-80 RD=0.93% [95% CI 0.45%, 1.41%], age 81-85 RD=2.14% [95% CI: 0.74%, 3.54%]). Secondary outcomes followed a similar pattern by age.

Conclusion: At ages 76-85, screening colonoscopy including downstream procedures are associated with an increased short-term risk of death or hospitalization.

Impact: Harms data can be combined with benefits data to guide screening colonoscopy decisions among older adults.