Identifying who best tolerates moderate sedation: Results from a national database of gastrointestinal endoscopic outcomes

Table 1 Demographic and clinical characteristics of low dose and high dose sedation groups

Variable	LD EGD (n = 25146), n (%)	HD EGD (n = 113281), n (%)	P value	LD colonoscopy (n = 37991), n (%)	HD colonoscopy (n = 194684), n (%)	P value
Age, mean ± SD	51.9 ± 21.9	58.2 ± 19.2	< 0.0001	56.8 ± 14.5	59.7 ± 22.6	< 0.0001
Female gender	13095 (52.1)	55617 (49.1)	< 0.0001	18548 (48.8)	89973 (46.2)	< 0.0001
Hispanic	6091 (24.2)	20479 (18.1)	< 0.0001	9052 (23.8)	22533 (11.6)	< 0.0001
White	19704 (78.4)	91529 (80.8)	< 0.0001	30643 (80.7)	168539 (86.6)	< 0.0001
Black	2084 (8.3)	6427 (5.7)	< 0.0001	2262 (6.0)	8605 (4.4)	< 0.0001
Asian	1284 (5.1)	3985 (3.5)	< 0.0001	2213 (5.8)	5484 (2.8)	< 0.0001
Other race	2025 (8.1)	9697 (8.6)	< 0.0001	3220 (8.5)	10100 (5.2)	< 0.0001
BMI (kg/m2), mean ± SD	27.8 ± 15.2	28.2 ± 19.8	< 0.0001	28.3 ± 19.9	28.2 ± 17	< 0.0001
Exam duration (min), mean ± SD	9 ± 12	10 ± 8	< 0.0001	20 ± 24	23 ± 23	< 0.0001
Medication dosage, mean ± IQR
Fentanyl (mcg)	45 ± 8.3	205.6 ± 11.1		47.6 ± 9	255.9 ± 15.3
Meperidine (µg)	33.9 ± 7.2	170.3 ± 10.4		45.7 ± 12.3	152.8 ± 11.6
Midazolam (mg)	1.3 ± 9.4	6.3 ± 19.7		1.8 ± 17.4	8.8 ± 21.2
Diphenhydramine (mg)	N/A	25.2 ± 13.5		N/A	50.3 ± 11.5
Personnel managing sedation, n (%)
Endoscopist	11522 (45.8)	63187 (55.8)	< 0.0001	15608 (41.1)	96376 (49.5)	< 0.0001
Anesthesiologist	13572 (54.0)	49656 (43.8)	< 0.0001	21288 (56.0)	89120 (45.8)	< 0.0001
Other	9042 (36.0)	216 (0.19)	< 0.0001	1095 (2.9)	46 (0.02)	< 0.0001
Unplanned intubations, n (%)	132 (0.5)	239 (0.2)	< 0.0001	5 (0.01)	19 (0.01)	< 0.0001
Aborted procedures, n (%)	5791 (23.0)	1371 (1.2)	< 0.0001	1602 (4.2)	341 (0.2)	< 0.0001
Admission status, n (%)
Inpatient	4936 (19.6)	12300 (10.9)	< 0.0001	1642 (4.3)	4894 (2.5)	< 0.0001
Outpatient	20204 (80.3)	100756 (88.9)	< 0.0001	36349 (95.7)	189631 (97.4)	< 0.0001
Location of procedure, n (%)
Ambulatory surgical center	14469 (57.5)	70643 (62.4)	< 0.0001	24967 (65.7%)	137399 (70.6)	< 0.0001
Endoscopy suite	9790 (38.9)	40263 (35.5)	< 0.0001	12735 (33.5)	56352 (28.9)	< 0.0001
Hospital ward	150 (0.6)	205 (0.2)	< 0.0001	24 (0.06)	72 (0.04)	< 0.0001
ICU	668 (2.7)	1678 (1.5)	< 0.0001	114 (0.3)	205 (0.1)	< 0.0001
Operating room	16 (0.1)	66 (0.06)	< 0.0001	4 (0.01)	18 (0.01)	< 0.0001
Other1	479 (1.9)	201 (0.2)	< 0.0001	147 (0.4)	47 (0.02)	< 0.0001

¹Other sites: Includes radiology suites and offices. LD: Low dose sedation group; HD: High dose sedation group; ICU: Intensive care unit; IQR: Interquartile range; SD: Standard deviation.

Table 2 Entire group analysis

Characteristic	Adjusted OR1 (95%CI)	P value
Age ≥ 50 vs < 50 (yr)	1.61 (1.57-1.65)	< 0.0001
BMI ≥ 25 vs < 25 (kg/m2)	0.81 (0.77-0.86)	< 0.0001
Females (vs males)	1.14 (1.12-1.16)	< 0.0001
African Americans vs Whites	1.51 (1.46-1.57)	< 0.0001
Asians vs Whites	2.29 (2.19-2.39)	< 0.0001
Hispanics vs Whites	2.06 (2.01-2.10)	< 0.0001
Colonoscopy vs EGD	0.97 (0.95-0.99)	0.001
Outpatient vs inpatient	0.70 (0.67-0.72)	< 0.0001
Completed: No vs yes	1.18 (1.12-1.24)	< 0.0001
ASA ≥ III vs ASA < III	1.45 (1.41-1.49)	< 0.0001
Location: OR vs endoscopy suite	0.97 (0.95-0.99)	0.005
Location: Other site2 vs endoscopy suite	1.25 (1.16-1.34)	< 0.0001
Duration: ≥ 30-60 vs < 30 (min)	0.96 (0.93-0.99)	0.02
Duration: > 60 vs < 30 (min)	0.52 (0.48-0.57)	< 0.0001

¹Adjusted odds ratios for all procedures requiring low dose sedation vs high dose sedation.

²Other site: Ambulatory surgery center, hospital ward, intensive care units, and radiology suite. EGD: Esophagogastroduodenoscopy; ASA: American Society of Anesthesia Class; OR: Odds ratio; CI: Confidence interval.

Table 3 Comparison of esophagogastroduodenoscopy and colonoscopy groups

Characteristic	EGD group adjusted OR1 (95%CI)	P value	Colonoscopy group adjusted OR1 (95%CI)	P value
Age ≥ 50 vs < 50 (yr)	2.23 (2.15-2.31)	< 0.0001	1.16 (1.13-1.20)	< 0.0001
BMI ≥ 25 vs < 25 (kg/m2)	1.18(1.09-1.28)	< 0.0001	0.67 (0.63-0.72)	< 0.0001
Females (vs males)	1.23 (1.19-1.26)	< 0.0001	1.08 (1.05-1.10)	< 0.0001
African Americans vs Whites	1.43 (1.35-1.51)	< 0.0001	1.54 (1.46-1.62)	< 0.0001
Asians vs Whites	1.73 (1.61-1.86)	< 0.0001	2.70 (2.56-2.85)	< 0.0001
Hispanics vs Whites	1.58 (1.53-1.64)	< 0.0001	2.49 (2.42-2.56)	< 0.0001
Outpatient vs inpatient	0.59 (0.57-0.62)	< 0.0001	0.85 (0.80-0.91)	< 0.0001
Completed: No vs yes	1.01 (0.89-1.14)	0.89	1.22 (1.15-1.29)	< 0.0001
ASA ≥ III vs ASA < III	1.44 (1.39-1.49)	< 0.0001	1.44 (1.39-1.50)	< 0.0001
Location: OR vs endoscopy suite	1.10 (1.06-1.14)	< 0.0001	0.91 (0.89-0.94)	< 0.0001
Location: Other site2 vs endoscopy suite	1.06 (0.97-1.16)	0.20	1.75 (1.51-2.01)	< 0.0001
Duration: ≥ 30-60 vs < 30 (min)	1.12 (1.07-1.17)	< 0.0001	0.81 (0.77-0.85)	< 0.0001
Duration: > 60 vs < 30 (min)	0.35 (0.27-0.45)	< 0.0001	0.55 (0.50-0.60)	< 0.0001

¹Adjusted odds ratios for esophagogastroduodenoscopy group and colonoscopy group requiring low dose sedation vs high dose sedation.

²Other site: Ambulatory surgery center, hospital ward, intensive care units, and radiology suite. EGD: Esophagogastroduodenoscopy; ASA: American Society of Anesthesia Class; OR: Odds ratio; CI: Confidence interval.