Cargando…

Risk of adverse events in gastrointestinal endoscopy: Zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event

BACKGROUND AND AIMS: We analyze the possible predictive variables for Adverse Events (AEs) during sedation for gastrointestinal (GI) endoscopy. METHODS: We consider 23,788 GI endoscopies under sedation on adults between 2012 and 2019. A Zero-Inflated Poisson Regression Mixture (ZIPRM) model for coun...

Descripción completa

Detalles Bibliográficos
Autores principales: Gemma, Marco, Pennoni, Fulvia, Tritto, Roberta, Agostoni, Massimo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245123/
https://www.ncbi.nlm.nih.gov/pubmed/34191840
http://dx.doi.org/10.1371/journal.pone.0253515
_version_ 1783716058923794432
author Gemma, Marco
Pennoni, Fulvia
Tritto, Roberta
Agostoni, Massimo
author_facet Gemma, Marco
Pennoni, Fulvia
Tritto, Roberta
Agostoni, Massimo
author_sort Gemma, Marco
collection PubMed
description BACKGROUND AND AIMS: We analyze the possible predictive variables for Adverse Events (AEs) during sedation for gastrointestinal (GI) endoscopy. METHODS: We consider 23,788 GI endoscopies under sedation on adults between 2012 and 2019. A Zero-Inflated Poisson Regression Mixture (ZIPRM) model for count data with concomitant variables is applied, accounting for unobserved heterogeneity and evaluating the risks of multi-drug sedation. A multinomial logit model is also estimated to evaluate cardiovascular, respiratory, hemorrhagic, other AEs and stopping the procedure risk factors. RESULTS: In 7.55% of cases, one or more AEs occurred, most frequently cardiovascular (3.26%) or respiratory (2.77%). Our ZIPRM model identifies one population for non-zero counts. The AE-group reveals that age >75 years yields 46% more AEs than age <66 years; Body Mass Index (BMI) ≥27 27% more AEs than BMI <21; emergency 11% more AEs than routine. Any one-point increment in the American Society of Anesthesiologists (ASA) score and the Mallampati score determines respectively a 42% and a 16% increment in AEs; every hour prolonging endoscopy increases AEs by 41%. Regarding sedation with propofol alone (the sedative of choice), adding opioids to propofol increases AEs by 43% and adding benzodiazepines by 51%. Cardiovascular AEs are increased by age, ASA score, smoke, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. Respiratory AEs are increased by BMI, ASA and Mallampati scores, emergency, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. Hemorrhagic AEs are increased by age, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. The risk of suspension of the endoscopic procedure before accomplishment is increased by female gender, ASA and Mallampati scores, and in-hospital, and it is reduced by emergency and procedure duration. CONCLUSIONS: Age, BMI, ASA score, Mallampati score, in-hospital, procedure duration, other sedatives with propofol increase the risk for AEs during sedation for GI endoscopy.
format Online
Article
Text
id pubmed-8245123
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-82451232021-07-09 Risk of adverse events in gastrointestinal endoscopy: Zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event Gemma, Marco Pennoni, Fulvia Tritto, Roberta Agostoni, Massimo PLoS One Research Article BACKGROUND AND AIMS: We analyze the possible predictive variables for Adverse Events (AEs) during sedation for gastrointestinal (GI) endoscopy. METHODS: We consider 23,788 GI endoscopies under sedation on adults between 2012 and 2019. A Zero-Inflated Poisson Regression Mixture (ZIPRM) model for count data with concomitant variables is applied, accounting for unobserved heterogeneity and evaluating the risks of multi-drug sedation. A multinomial logit model is also estimated to evaluate cardiovascular, respiratory, hemorrhagic, other AEs and stopping the procedure risk factors. RESULTS: In 7.55% of cases, one or more AEs occurred, most frequently cardiovascular (3.26%) or respiratory (2.77%). Our ZIPRM model identifies one population for non-zero counts. The AE-group reveals that age >75 years yields 46% more AEs than age <66 years; Body Mass Index (BMI) ≥27 27% more AEs than BMI <21; emergency 11% more AEs than routine. Any one-point increment in the American Society of Anesthesiologists (ASA) score and the Mallampati score determines respectively a 42% and a 16% increment in AEs; every hour prolonging endoscopy increases AEs by 41%. Regarding sedation with propofol alone (the sedative of choice), adding opioids to propofol increases AEs by 43% and adding benzodiazepines by 51%. Cardiovascular AEs are increased by age, ASA score, smoke, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. Respiratory AEs are increased by BMI, ASA and Mallampati scores, emergency, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. Hemorrhagic AEs are increased by age, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. The risk of suspension of the endoscopic procedure before accomplishment is increased by female gender, ASA and Mallampati scores, and in-hospital, and it is reduced by emergency and procedure duration. CONCLUSIONS: Age, BMI, ASA score, Mallampati score, in-hospital, procedure duration, other sedatives with propofol increase the risk for AEs during sedation for GI endoscopy. Public Library of Science 2021-06-30 /pmc/articles/PMC8245123/ /pubmed/34191840 http://dx.doi.org/10.1371/journal.pone.0253515 Text en © 2021 Gemma et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Gemma, Marco
Pennoni, Fulvia
Tritto, Roberta
Agostoni, Massimo
Risk of adverse events in gastrointestinal endoscopy: Zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event
title Risk of adverse events in gastrointestinal endoscopy: Zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event
title_full Risk of adverse events in gastrointestinal endoscopy: Zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event
title_fullStr Risk of adverse events in gastrointestinal endoscopy: Zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event
title_full_unstemmed Risk of adverse events in gastrointestinal endoscopy: Zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event
title_short Risk of adverse events in gastrointestinal endoscopy: Zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event
title_sort risk of adverse events in gastrointestinal endoscopy: zero-inflated poisson regression mixture model for count data and multinomial logit model for the type of event
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245123/
https://www.ncbi.nlm.nih.gov/pubmed/34191840
http://dx.doi.org/10.1371/journal.pone.0253515
work_keys_str_mv AT gemmamarco riskofadverseeventsingastrointestinalendoscopyzeroinflatedpoissonregressionmixturemodelforcountdataandmultinomiallogitmodelforthetypeofevent
AT pennonifulvia riskofadverseeventsingastrointestinalendoscopyzeroinflatedpoissonregressionmixturemodelforcountdataandmultinomiallogitmodelforthetypeofevent
AT trittoroberta riskofadverseeventsingastrointestinalendoscopyzeroinflatedpoissonregressionmixturemodelforcountdataandmultinomiallogitmodelforthetypeofevent
AT agostonimassimo riskofadverseeventsingastrointestinalendoscopyzeroinflatedpoissonregressionmixturemodelforcountdataandmultinomiallogitmodelforthetypeofevent