Colonoscopy in Nonagenarians Is Safe and May Be Associated With Clinical Benefit

Asher Shafrir, MD; Benjamin Koslowsky, MD; Dov Wengrower, MD; Eran Goldin, MD; Dan M. Livovsky, MD

Disclosures

J Am Geriatr Soc. 2019;67(6):1158-1163. 

In This Article

Methods

Using the computer database of the Shaare Zedek Medical Center, we performed a retrospective analysis of all (n = 128) patients 90 years or older who underwent colonoscopy between January 2013 and May 2017 and compared them with 218 consecutive patients aged 80 to 89 years who underwent colonoscopy at our center. We compared the indication for colonoscopy, sedative medication dosage, colonoscopy completion, bowel preparation quality, adverse events, diagnostic yield, characteristics and pathology of detected lesions, treatment changes following the finding of CRC, and 30-day mortality. Bowel perforation or cardiopulmonary decompensation requiring intubation and/or resuscitation were considered severe adverse events.

Statistical Analysis

Descriptive statistics were used to compare baseline demographic characteristics of both groups. Patients' data and clinical parameters are given as means with standard deviation for normally distributed variables and as median with range or interquartile range (IQR) in parentheses, as indicated, for nonnormally distributed variables. For categorical variables, results are reported as absolute numbers with population proportions (percentages) in parentheses or vice versa as indicated. To analyze differences in the distribution of categorical data, the χ2 or Fisher exact test was used, as appropriate. Continuous variables were analyzed by t test or the Mann-Whitney U test for normally or nonnormally distributed variables, respectively. Logistic regression with backward stepwise variable selection was used to identify the independent predictors for the finding of CRC. Odds ratios (ORs) are provided with 95% confidence intervals in parentheses. To calculate the OR of variables in which one of the cells in the two by two tables was zero, we used the Haldane-Anscombe correction.[10,11] Kaplan-Meier survival curves were calculated, and the log-rank test was used to compare all-cause mortality among octogenarians and nonagenarians diagnosed with CRC as well as among patients who received operative or palliative treatment. Two-tailed tests with a significance level of 5% were used in all analyses. All calculations were performed using SPSS v.20 software (IBM Corp, Chicago, IL).

Ethical Review Board Approval

The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki and was approved a priori by the ethical review board of Shaare Zedek Medical Center, which is also our institution's human research committee. The approval was obtained on the November 15, 2017, signed by Prof. Avraham Steinberg, the head of the committee. The data for this study were obtained from an existing database, patients were deidentified, and data were anonymized therefore the ethical review board exempted us from obtaining individually signed informed consent.

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