{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T07:56:21Z","timestamp":1780732581943,"version":"3.54.1"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T00:00:00Z","timestamp":1608681600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>Anesthesia services for endoscopic procedures have proliferated with the promise of increased comfort and safety. Cirrhosis patients are higher risk for sedation, yet limited data are available describing anesthesia complications in this population.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>This cross\u2010sectional study utilized the National Anesthesia Clinical Outcomes Registry, a multicenter quality\u2010improvement database from 2010 to 2015. Patients with cirrhosis undergoing an endoscopy were identified by International Classification of Diseases, Ninth Revision (ICD\u20109)\/Current Procedures Terminology (CPT) codes. The outcome of interest was serious anesthesia\u2010related complication defined as cardiovascular, respiratory, neurological, drug related, patient injury, death, or unexpected admission. A mixed\u2010effects multivariate logistic regression model determined odds ratios (ORs) between variables and serious complications, adjusting for potential confounders. In total, 9,007 endoscopic procedures were performed among patients with cirrhosis; 92% were esophagogastroduodenoscopies. The majority (81%) were American Society of Anesthesiologists (ASA) class \u22653, and 72% had a history of hepatic encephalopathy, ascites, varices, hepatorenal syndrome, or spontaneous bacterial peritonitis identified by ICD\u20109\/CPT codes. In total, 87 complications were reported, 33 of which were serious. Frequency of serious complications was 0.4% or 378.6 per 100,000 procedures (95% confidence interval [CI], 260.8, 531.3). The majority of serious complications were cardiovascular (21 of 33), including 15 cardiac arrests. Serious complications were significantly associated with ASA 4<jats:bold>\/<\/jats:bold>5 (OR, 3.84; 95% CI, 1.09, 13.57) and general anesthesia (OR, 4.71; 95% CI, 1.20, 18.50), adjusting for age, sex, ASA class, anesthesia type, inpatient status, portal hypertension history, and variable complication reporting practices.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Anesthesia complications among endoscopic procedures in cirrhosis are rare overall. Serious complications were predominantly cardiac and associated with sicker patients undergoing general anesthesia. The complexity of end\u2010stage liver disease may warrant more intensive care during endoscopic procedures, including anesthesia monitoring.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.31224","type":"journal-article","created":{"date-parts":[[2020,3,10]],"date-time":"2020-03-10T07:05:48Z","timestamp":1583823948000},"page":"2109-2118","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":22,"title":["Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis"],"prefix":"10.1097","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8304-4479","authenticated-orcid":false,"given":"Sarah R.","family":"Lieber","sequence":"first","affiliation":[{"name":"Department of Medicine,Division of Gastroenterology and Hepatology,University of North Carolina (UNC) Health Care,Chapel Hill,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4742-5116","authenticated-orcid":false,"given":"Benjamin J.","family":"Heller","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology,University of North Carolina (UNC) Health Care,Chapel Hill,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0392-0270","authenticated-orcid":false,"given":"Christopher W.","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology,University of North Carolina (UNC) Health Care,Chapel Hill,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1323-6245","authenticated-orcid":false,"given":"Robert S.","family":"Sandler","sequence":"additional","affiliation":[{"name":"Department of Medicine,Division of Gastroenterology and Hepatology,University of North Carolina (UNC) Health Care,Chapel Hill,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2955-2963","authenticated-orcid":false,"given":"Seth","family":"Crockett","sequence":"additional","affiliation":[{"name":"Department of Medicine,Division of Gastroenterology and Hepatology,University of North Carolina (UNC) Health Care,Chapel Hill,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4200-3256","authenticated-orcid":false,"given":"Alfred Sidney","family":"Barritt","sequence":"additional","affiliation":[{"name":"Department of Medicine,Division of Gastroenterology and Hepatology,University of North Carolina (UNC) Health Care,Chapel Hill,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,12,23]]},"reference":[{"key":"hep31224-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1111\/j.1572-0241.2006.00500.x","article-title":"Endoscopic sedation in the United States: results from a nationwide survey","volume":"101","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"hep31224-bib-0002-20241017","first-page":"1178\u20101184","article-title":"Utilization of anesthesia services during outpatient endoscopies and colonoscopies and associated spending in 2003\u20102009","volume":"307","year":"2012","journal-title":"JAMA"},{"key":"hep31224-bib-0003-20241017","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.gie.2010.04.040","article-title":"Projected increased growth rate of anesthesia professional\u2014delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015","volume":"72","year":"2010","journal-title":"Gastrointest Endosc"},{"key":"hep31224-bib-0004-20241017","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.gie.2010.09.025","article-title":"Sedation during upper GI endoscopy in cirrhotic outpatients: a randomized, controlled trial comparing propofol and fentanyl with midazolam and fentanyl","volume":"73","year":"2011","journal-title":"Gastrointest Endosc"},{"key":"hep31224-bib-0005-20241017","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/MEG.0b013e32834c16ab","article-title":"Safety of propofol in cirrhotic patients undergoing colonoscopy and endoscopic retrograde cholangiography","volume":"24","year":"2012","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"hep31224-bib-0006-20241017","first-page":"25","article-title":"Conscious sedation using propofol versus midazolam in cirrhotic patients during upper GI endoscopy: a comparative study. 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