{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T18:37:21Z","timestamp":1781894241514,"version":"3.54.5"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T00:00:00Z","timestamp":1708646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The incidence of 30-day postoperative pulmonary complications (PPC) of gastrointestinal endoscopic procedures (GIEP) are not well characterized in the literature. The primary aim of this study was to identify the incidence of 30-day PPC after GIEP within a large healthcare system. We conducted a retrospective cohort study of 5377 patients presenting for GIEP between January 2013 and January 2022. Our primary outcome was the Agency for Healthcare Research and Quality PPC composite (AHRQ-PPC). Secondary outcomes were sub-composites derived from the AHRQ-PPC; including pneumonia (AHRQ-PNA), respiratory failure (AHRQ-RF), aspiration pneumonia\/ pneumonitis (AHRQ-ASP) and pulmonary emboli (AHRQ-PE). We performed propensity score matching (PSM) followed by multivariable logistic regression to analyze primary and secondary outcomes. Inpatients had higher 30-day AHRQ-PPC (6.0 vs. 1.2%, p&lt;0.001), as well as sub-composite AHRQ-PNA (3.2 vs. 0.7%, p&lt;0.001), AHRQ-RF (2.4 vs. 0.5%, p&lt;0.001), and AHRQ-ASP (1.9 vs. 0.4%, p&lt;0.001). After PSM adjustment, pre-procedural comorbidities of electrolyte disorder [57.9 vs. 31.1%, ORadj: 2.26, 95%CI (1.48, 3.45), p&lt;0.001], alcohol abuse disorder [16.7 vs. 6.8%, OR<jats:sub>adj<\/jats:sub>: 2.66 95%CI (1.29, 5.49), p = 0.01], congestive heart failure (CHF) [22.3 vs. 8.7%, OR<jats:sub>adj<\/jats:sub>: 2.2 95%CI (1.17, 4.15), p = 0.02] and pulmonary circulatory disorders [21 vs. 16.9%, OR<jats:sub>adj<\/jats:sub>: 2.95, 95%CI (1.36, 6.39), p = 0.01] were associated with 30-day AHRQ-PPC. After covariate adjustment, AHRQ-PPC was associated with upper endoscopy more than lower endoscopy [5.9 vs. 1.0%, OR<jats:sub>adj<\/jats:sub>: 3.76, 95%CI (1.85, 7.66), p&lt;0.001]. When compared to gastroenterologist-guided conscious sedation, anesthesia care team presence was protective against AHRQ-PPC [3.7 vs. 8.4%, OR<jats:sub>adj<\/jats:sub>: 0.032, 95%CI (0.01, 0.22), p&lt;0.001] and AHRQ-ASP [1.0 vs. 3.37%, OR<jats:sub>adj<\/jats:sub>: 0.002, 95%CI (0.00, 0.55), p&lt;0.001]. In conclusion, we report estimates of 30-day PPC after GIEP across inpatient and outpatient settings. Upper endoscopic procedures confer a higher risk, while the presence of an anesthesia care team may be protective against 30-day PPC.<\/jats:p>","DOI":"10.1371\/journal.pone.0299137","type":"journal-article","created":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T18:53:32Z","timestamp":1708714412000},"page":"e0299137","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Estimates of 30-day postoperative pulmonary complications after gastrointestinal endoscopic procedures: A retrospective cohort analysis of a health system population"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6970-3340","authenticated-orcid":true,"given":"Zyad J.","family":"Carr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8755-6751","authenticated-orcid":true,"given":"Judy","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Agarkov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makenzie","family":"Gazura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunal","family":"Karamchandani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,2,23]]},"reference":[{"issue":"1","key":"pone.0299137.ref001","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgast-2021-000688","article-title":"Complications of diagnostic upper Gastrointestinal endoscopy: common and rare\u2014recognition, assessment and management","volume":"9","author":"W Waddingham","year":"2022","journal-title":"BMJ Open Gastroenterol"},{"issue":"3","key":"pone.0299137.ref002","doi-asserted-by":"crossref","first-page":"255","DOI":"10.15403\/jgld.2014.1121.233.kf1","article-title":"Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation","volume":"23","author":"K Friedrich","year":"2014","journal-title":"Journal of Gastrointestinal and Liver Diseases"},{"key":"pone.0299137.ref003","first-page":"45","article-title":"The Incidence of Postoperative Pneumonia in Various Surgical Subspecialties: A Dual Database Analysis","volume":"30","author":"M Chughtai","year":"2017","journal-title":"Surg Technol Int"},{"issue":"9","key":"pone.0299137.ref004","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1097\/EJA.0000000000000845","article-title":"The LAS VEGAS risk score for prediction of postoperative pulmonary complications: An observational study","volume":"35","author":"AS Neto","year":"2018","journal-title":"European journal of anaesthesiology"},{"issue":"4","key":"pone.0299137.ref005","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1007\/s13304-020-00892-6","article-title":"Predicting primary postoperative pulmonary complications in patients undergoing minimally invasive surgery for colorectal cancer","volume":"72","author":"MA Abd El Aziz","year":"2020","journal-title":"Updates Surg"},{"issue":"2","key":"pone.0299137.ref006","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.surg.2020.08.009","article-title":"Relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned readmissions in the ACS NSQIP database","volume":"169","author":"DM Aasen","year":"2021","journal-title":"Surgery"},{"issue":"1","key":"pone.0299137.ref007","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/j.1475-6773.2008.00905.x","article-title":"Validity of selected AHRQ patient safety indicators based on VA National Surgical Quality Improvement Program data","volume":"44","author":"PS Romano","year":"2009","journal-title":"Health Serv Res"},{"key":"pone.0299137.ref008","unstructured":"Group MPO. Standardized Data File\u2014Appendix 1 Phenotype Specifications. AHRQ Complication\u2014Pulmonary\u2014Administrative. https:\/\/mpog.org\/: Multicenter Perioperative Outcomes Group; 2020. p. 3\u20134."},{"issue":"10","key":"pone.0299137.ref009","doi-asserted-by":"crossref","first-page":"e297","DOI":"10.1371\/journal.pmed.0040297","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration","volume":"4","author":"JP Vandenbroucke","year":"2007","journal-title":"PLoS Med"},{"issue":"28","key":"pone.0299137.ref010","doi-asserted-by":"crossref","first-page":"3661","DOI":"10.1002\/sim.6607","article-title":"Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies","volume":"34","author":"PC Austin","year":"2015","journal-title":"Stat Med"},{"issue":"3","key":"pone.0299137.ref011","doi-asserted-by":"crossref","first-page":"e510","DOI":"10.1016\/j.ejrad.2010.10.030","article-title":"Clinically unrecognized pulmonary aspiration during gastrointestinal endoscopy with sedation: a potential pitfall interfering the performance of 18F-FDG PET for cancer screening","volume":"80","author":"TC Hsieh","year":"2011","journal-title":"Eur J Radiol"},{"issue":"4","key":"pone.0299137.ref012","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1155\/2007\/307937","article-title":"Aspiration in the context of upper gastrointestinal endoscopy","volume":"21","author":"A Thomson","year":"2007","journal-title":"Canadian Journal of Gastroenterology"},{"issue":"9","key":"pone.0299137.ref013","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1007\/s11606-008-0672-3","article-title":"The impact of pre-existing heart failure on pneumonia prognosis: population-based cohort study","volume":"23","author":"RW Thomsen","year":"2008","journal-title":"J Gen Intern Med"},{"issue":"4","key":"pone.0299137.ref014","first-page":"392","article-title":"Postoperative pulmonary complications in contemporary cohort of patients with pulmonary hypertension","volume":"19","author":"SC Kruthiventi","year":"2019","journal-title":"Bosn J Basic Med Sci"},{"issue":"1","key":"pone.0299137.ref015","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12890-017-0570-8","article-title":"Risk factors of postoperative pulmonary complications in patients with asthma and COPD","volume":"18","author":"T Numata","year":"2018","journal-title":"BMC pulmonary medicine"},{"issue":"6","key":"pone.0299137.ref016","doi-asserted-by":"crossref","first-page":"e195172","DOI":"10.1001\/jamanetworkopen.2019.5172","article-title":"Association Between Alcohol Use Disorders and Outcomes of Patients Hospitalized With Community-Acquired Pneumonia","volume":"2","author":"NM Gupta","year":"2019","journal-title":"JAMA Netw Open"},{"key":"pone.0299137.ref017","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.jss.2023.09.030","article-title":"Predictors of Failure to Rescue After Postoperative Respiratory Failure: A Retrospective Cohort Analysis of 13,047 Patients Using the ACS-NSQIP Dataset","volume":"293","author":"K Karamchandani","year":"2023","journal-title":"The Journal of surgical research"},{"issue":"4Part-II","key":"pone.0299137.ref018","first-page":"928","article-title":"Tracheobronchial aspiration affects the outcome of hospitalization among Hepatic Encephalopathy patients","volume":"38","author":"Q Rafiq","year":"2022","journal-title":"Pak J Med Sci"},{"issue":"2","key":"pone.0299137.ref019","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.soard.2012.01.025","article-title":"Risk factors for acute respiratory failure in bariatric surgery: data from the Nationwide Inpatient Sample, 2006\u20132008","volume":"9","author":"H Masoomi","year":"2013","journal-title":"Surg Obes Relat Dis"},{"issue":"4","key":"pone.0299137.ref020","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/MCC.0b013e328348bef5","article-title":"Renal dysfunction and fluid and electrolyte disturbances","volume":"17","author":"R Hashem","year":"2011","journal-title":"Current opinion in critical care"},{"issue":"2","key":"pone.0299137.ref021","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00134-009-1692-0","article-title":"Incidence and prognosis of dysnatremias present on ICU admission","volume":"36","author":"GC Funk","year":"2010","journal-title":"Intensive Care Med"},{"issue":"6","key":"pone.0299137.ref022","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1053\/j.jvca.2017.04.005","article-title":"Patient Selection and Outcomes of Transfemoral Transcatheter Aortic Valve Replacement Performed with Monitored Anesthesia Care Versus General Anesthesia","volume":"31","author":"S Pani","year":"2017","journal-title":"Journal of cardiothoracic and vascular anesthesia"},{"key":"pone.0299137.ref023","doi-asserted-by":"crossref","first-page":"2318489","DOI":"10.1155\/2018\/2318489","article-title":"Conscious Sedation versus General Anesthesia for Patients with Acute Ischemic Stroke Undergoing Endovascular Therapy: A Systematic Review and Meta-Analysis","volume":"2018","author":"R Jing","year":"2018","journal-title":"BioMed research international"},{"issue":"1","key":"pone.0299137.ref024","doi-asserted-by":"crossref","first-page":"9","DOI":"10.5114\/ait.2023.125416","article-title":"Comparing general anaesthesia versus sedation for endoscopic submucosal dissection: results from a systematic review and meta-analysis","volume":"55","author":"CM Leung","year":"2023","journal-title":"Anaesthesiol Intensive Ther"},{"issue":"4","key":"pone.0299137.ref025","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.gie.2018.09.001","article-title":"A randomized controlled trial evaluating general endotracheal anesthesia versus monitored anesthesia care and the incidence of sedation-related adverse events during ERCP in high-risk patients","volume":"89","author":"ZL Smith","year":"2019","journal-title":"Gastrointest Endosc"},{"issue":"2","key":"pone.0299137.ref026","first-page":"172","article-title":"Oxygen saturation during esophagogastroduodenoscopy in children: general anesthesia versus intravenous sedation","volume":"27","author":"T Lamireau","year":"1998","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"7","key":"pone.0299137.ref027","doi-asserted-by":"crossref","first-page":"2842","DOI":"10.1016\/j.asjsur.2023.01.067","article-title":"Complications of moderate sedation versus monitored anesthesia care in endoscopic retrograde cholangiopancreatography: A retrospective analysis","volume":"46","author":"A Ren","year":"2023","journal-title":"Asian J Surg"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0299137","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T18:53:49Z","timestamp":1708714429000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0299137"}},"subtitle":[],"editor":[{"given":"Sina","family":"Azadnajafabad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,2,23]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0299137","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,23]]}}}