The Resource Colonoscopy outcomes by duration of NPO status prior to colonoscopy with moderate or deep sedation, prepared for Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service ; prepared by Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center ; prinicpal investigator: Aasma Shaukat ; co-investigators: Joseph Wels, Ashish Malhotra, Nancy Greer, Timothy J. Wilt ; research assistants: Roderick MacDonald, Maureen Carlyle, Indulis Rutks

Colonoscopy outcomes by duration of NPO status prior to colonoscopy with moderate or deep sedation, prepared for Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service ; prepared by Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center ; prinicpal investigator: Aasma Shaukat ; co-investigators: Joseph Wels, Ashish Malhotra, Nancy Greer, Timothy J. Wilt ; research assistants: Roderick MacDonald, Maureen Carlyle, Indulis Rutks

Label
Colonoscopy outcomes by duration of NPO status prior to colonoscopy with moderate or deep sedation
Title
Colonoscopy outcomes by duration of NPO status prior to colonoscopy with moderate or deep sedation
Statement of responsibility
prepared for Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service ; prepared by Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center ; prinicpal investigator: Aasma Shaukat ; co-investigators: Joseph Wels, Ashish Malhotra, Nancy Greer, Timothy J. Wilt ; research assistants: Roderick MacDonald, Maureen Carlyle, Indulis Rutks
Creator
Contributor
Author
Issuing body
Subject
Language
eng
Summary
Fourteen million colonoscopies are performed annually in the United States for screening, diagnosis, surveillance, and treatment of numerous colonic conditions. Colonoscopies require bowel preparation for cleansing to sufficiently visualize the colon lining, identify and treat suspected lesions, and maximize quality and safety. To optimize colon lining visualization, patients are advised to divide the bowel preparation regimen over two sessions (known as "split-dose preparation"): 1) the evening prior to the colonoscopy (PM dose) and 2) the morning of the colonoscopy (AM dose), the latter taken ideally within 2-6 hours of the planned procedure. In addition, some level of sedation (typically moderate or deep) is used in almost all colonoscopies to facilitate patient comfort and procedure quality. There is significant variation among anesthesia providers as to the acceptable timing of NPO ("nothing by mouth"), including how many hours prior to the planned procedure the last bowel preparation dose can be taken, in order to minimize anesthesia risk (primarily pulmonary aspiration requiring hospitalization). Practice guidelines from the American Society of Anesthesiologists suggest a minimum fasting period of 2 hours for clear liquids and 6 hours for a light meal (ie, toast and clear liquids). The guideline authors note that published clinical evidence is insufficient to clearly define a relationship between NPO status and risk of emesis/reflux or aspiration. There is a need to balance optimal colonic preparation, patient convenience, and scheduling efficiency (typically a shorter NPO window status) with anesthesia safety concerns for an elective procedure (typically a longer NPO status). In addition, performing procedures with moderate or deep sedation requires development of and adherence to local and/or national policy measures that cross multiple procedures and physician specialties. These policies include recommendations regarding NPO status. The purpose of this report was to review the evidence on the relationship between timing of NPO and 1) the incidence of aspiration and other anesthesia-related harms during elective colonoscopy and 2) colonoscopy rescheduling. We also reviewed the evidence on the benefits and harms of variable timing of NPO status on colonoscopy outcomes including colonoscopy quality measures, resource use, and patient satisfaction. The review may be used to guide policy within the VA. We addressed the following key questions: Key Question 1. Does the incidence of aspiration and other anesthesia-related harms for colonoscopy vary by NPO status or bowel prep timing (eg, > 6 hours, 2-6 hours, < 4 hours, and < 2 hours)? Does the incidence of anesthesia-related harms by NPO status vary by: a) patient characteristics (age, race, sex, obesity, comorbidities) or b) sedation (moderate, deep)? Key Question 2. What is the effect of variable timing of bowel prep and NPO status on the quality of the bowel preparation, diagnostic yield, and colonoscopy procedural quality indicators (eg, completion rates, adenoma detection rate, total procedure time, cecal intubation time and withdrawal time)? Key Question 3. What is the effect of NPO status prior to colonoscopy on resource use (eg, costs, unused procedure slots, delays in rescheduling, delays in diagnosis, increased volume of procedures, scheduler and nursing time associated with cancelled or delayed procedures)? Key Question 4. What is the effect of bowel preparation and NPO status prior to colonoscopy on patient adherence to bowel preparation, colonoscopy, and/or rescheduled colonoscopy, and satisfaction with bowel preparation and/or colonoscopy?
Member of
Cataloging source
DNLM
http://library.link/vocab/creatorName
Shaukat, Aasma
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
NLM call number
WI 520
http://library.link/vocab/relatedWorkOrContributorName
  • Wels, Joseph
  • Malhotra, Ashish
  • Greer, Nancy L.
  • Wilt, Timothy J.
  • United States
  • Quality Enhancement Research Initiative (U.S.)
  • Minneapolis VA Health Care System (U.S.)
Series statement
Evidence-based synthesis program
http://library.link/vocab/subjectName
  • Colonoscopy
  • Conscious Sedation
  • Deep Sedation
  • Preoperative Care
  • Time Factors
  • Treatment Outcome
Label
Colonoscopy outcomes by duration of NPO status prior to colonoscopy with moderate or deep sedation, prepared for Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service ; prepared by Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center ; prinicpal investigator: Aasma Shaukat ; co-investigators: Joseph Wels, Ashish Malhotra, Nancy Greer, Timothy J. Wilt ; research assistants: Roderick MacDonald, Maureen Carlyle, Indulis Rutks
Instantiates
Publication
Note
"January 2015."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Color
multicolored
Content category
  • text
  • still image
Content type code
  • txt
  • sti
Content type MARC source
  • rdacontent
  • rdacontent
Control code
920232705
Dimensions
unknown
Extent
1 online resource (iv, 96 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)920232705
Label
Colonoscopy outcomes by duration of NPO status prior to colonoscopy with moderate or deep sedation, prepared for Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service ; prepared by Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center ; prinicpal investigator: Aasma Shaukat ; co-investigators: Joseph Wels, Ashish Malhotra, Nancy Greer, Timothy J. Wilt ; research assistants: Roderick MacDonald, Maureen Carlyle, Indulis Rutks
Publication
Note
"January 2015."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Color
multicolored
Content category
  • text
  • still image
Content type code
  • txt
  • sti
Content type MARC source
  • rdacontent
  • rdacontent
Control code
920232705
Dimensions
unknown
Extent
1 online resource (iv, 96 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)920232705

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