When is it safe to discharge patients following colonoscopy? Validation of the Aldrete score.

N. Hickey, BSc, M. O’Leary, BSc, V. Falk, MD, D. Pace, MD, M. Borgaonkar, MD, MSc

Memorial University of Newfoundland- Faculty of Medicine

Aim: The Aldrete scoring system has been used as a criteria for safe discharge in Anesthesiology. Although used for the same purpose following GI endoscopy, it has not been validated in this setting. This study aims to ascertain the relationship between the Aldrete score on discharge and sedation related adverse events in patients undergoing outpatient colonoscopies.
Methods: A retrospective case study analysis was performed on 649 adults who had colonoscopies between January and June 2012 at a tertiary referral institution. Using a hospital based electronic medical records system, data were collected on cecal intubation rates, amount and type of sedation used, adenoma and colorectal cancer detection rates, Aldrete scores on discharge and presence of sedation related adverse events. Sedation related adverse events were defined as: need for reversal agents, need for CPR, hypoxia (O2 sat <85%), hypotension (BP < 90/50) and allergic reaction. Any deaths or hospital admissions were assessed to determine if they were sedation related. Data was analyzed using SPSS version 19.0 software.
Results: The mean age of patients was 47.7 years +/- 12.2 years. 51.3% of patients were female. 92.6% of colonoscopies were completed to cecum or terminal ileum. Adenoma detection rate was 24.5% and colorectal cancer was identified in 3.4% of cases. Aldrete score was noted in 514 patients and was greater than or equal to 9 in 511 of those cases. Supplemental O2 was used in 34.5% of cases. Hypoxia occurred in 1.4% of patients. Hypotension occurred in 5.2% of cases. There were no allergic reactions, no need for CPR and no need for reversal agents.There were 4 unplanned hospitalizations and 7 ER visits within 14 days of the procedure. Of these, only 1 may have been sedation related for which bradycardia and hypotension occurred.
Conclusion: Patients discharged post colonoscopy with an Aldrete score of 9 or greater had a 0.2% incidence of a possible sedation related event. This suggests that the Aldrete score can be used to determine safe discharge home post- colonoscopy.

Session: Poster Presentation

Program Number: P075