Risk of Mortality after Colonoscopy in Taiwan: A Nationwide Population-Based Nested Case-Control Study

大腸鏡後病患死亡風險因子分析

張文榮(Wen-Jung Chang) ； 簡戊鑑(Wu-Chien Chien) ； 陳昭仰(Chao-Yang Chen) ； 饒樹文(Shu-Wen Jao) ； 張筆凱(Pi-Kai Chang) ； 鍾其祥(Chi-Hsiang Chung) ； 浦大為(Ta-Wei Pu) ； 林子喬(Tzu-Chiao Lin) ； 胡哲銘(Je-Ming Hu)

《中華民國大腸直腸外科醫學會雜誌》 31卷4期 (2020/12) Pp. 229-245

https://doi.org/10.6312/SCRSTW.202012_31(4).10912

摘要

Purpose. Colonoscopic perforation is widely recognized as one of the most serious complications of lower gastrointestinal endoscopy procedures. Using the National Health Insurance Research Database, this study aimed to assess the incidence and risk factors associated with mortality after colonoscopic perforation in Taiwan. Methods. Data was collected from the National Health Insurance Research Database over an 10-year period. Variables were analyzed with Pearson's chi-squared test and Fisher's exact test. Risk factors for mortality were examined using the adjusted hazard ratio. Kaplan-Meier analysis was performed to compare survival of patients after colonoscopic perforation. Results. A total of 307 patients with colonoscopic perforation comprised the study cohort, and 103,505 patients without colonoscopic perforation comprised the control cohort. The rate of colonoscopic perforation within 30 days was 0.3% (307/103,812). The overall mortality rate within 30 days in patients with colonosopic perforation was 3.91% (12/307). Based on the multivariate analysis results, males, older patients, and patients with comorbidities (e.g., diabetes mellitus, end-stage renal disease, stroke, diverticulitis) and post-polypectomy showed an increased risk of mortality after colonoscopic perforation. Conclusions. Based on a retrospective follow-up study in Taiwan, males, elderly patients, and patients with comorbidities and post-polypectomy had an increased risk of mortality after colonoscopic perforation. Further studies are needed to confirm the association and the underlying mechanisms.

關鍵字

Mortality ； Colonoscopic perforation ； National Health Insurance Research Database ； Retrospective cohort study

並列摘要

目的：大腸鏡後產生之大腸破裂（CP）被認為是下消化道內鏡檢查最嚴重的併發症之一。本篇研究使用全民健康保險研究資料庫（NHIRD）來評估台灣因大腸鏡檢查產生大腸破裂後死亡的發生率和危險因子分析。方法：本篇為回朔性的研究文章，從全民健康保險研究資料庫（NHIRD）收集了從2000年至2010年、共10年的數據。使用皮爾森卡方檢定（Pearson chi-square test）以及費雪精確檢定（Fisher's exact test）對變量進行了分析，並以Kaplan-Meier分析法來比較大腸鏡後產生大腸破裂之病患的存活率。結果：共有307名大腸鏡後產生大腸破裂之病患納入本篇研究之研究組，而對照組中則有103,505名大腸鏡後未產生大腸破裂之病患。在大腸鏡後30天內產生大腸破裂之機率為0.3％（307/103812）。這些被診斷為CP的人在30天內的總死亡率為3.91％（12/307）。由多變量分析的結果顯示男性、老年人、患有合併症的病患（例如糖尿病、末期腎病、中風和憩室炎）以及在接受大腸鏡瘜肉切除術之患者的CP後死亡風險增加。結論：根據本篇以全民健康保險研究資料庫（NHIRD）進行的全國性回顧性研究中，男性、老年人、合併症患者以及大腸鏡瘜肉切除術後均與CP術後死亡風險之增加有相關性，因此在這些病患如發生CP則應考慮採取更積極的外科手術治療以期降低死亡率。

並列關鍵字

死亡率 ； 大腸鏡後大腸破裂 ； 全民健康保險研究資料庫 ； 回顧性研究

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