Clinical Study Of Post-discharge Adverse Events After Painless Gastrointestinal Endoscopy Consultation In Elderly Frail Patients

Objective: To identify the occurrence of post-discharge adverse events after painless gastrointestinal endoscopy consultation in elderly frail patients,focusing on the top three risk factors for PDAEs in terms of incidence.Methods: A total of 943 elderly patients who underwent PGIE at the endoscopy center of Northern Jiangsu People’s Hospital between May 2021 and September 2021 were included in this study.Patients were divided into non-frailty group(NF group),pre-frailty group(PF group)and frailty group(F group)according to the Fried Frailty Phenotype.General information,personal history and lifestyle,current and past medical history,intraoperative conditions,and anesthesia resuscitation were collected,and patients were followed up at 12 h,24h,and 36 h postoperatively for PDAEs.A total of 23 PDAEs were included,including postoperative fatigue syndrome(POFS),vertigo,abdominal pain,gastrointestinal distention,PONV,cognitive impairment,chest pain,and fall.the severity of POFS was determined using the Christensen fatigue scale,and the severity of the remaining PDAEs was determined using the Common Terminology Criteria for Adverse Events(CTCAE),version 5.0.the duration of PDAEs was defined as the time from when the patient left the endoscopy center until the time of complete disappearance of the adverse symptoms.The types,incidence,severity and duration of PDAEs in the F,PF and NF groups were compared.Multi-factor logistic regression analysis was used,focusing on the top three incidence of PDAEs in group F.Results: A total of 15 PDAEs occurred: POFS,gastrointestinal distension,vertigo,abdominal pain,bloating,headache,PONV,sore throat,diarrhea,belch,gastric discomfort,jaw discomfort and blood in stool.Compared with the NF group,the incidence of headache was significantly higher in the F and PF groups(P < 0.05),Compared with the PF and NF group,the incidence of vertigo was significantly higher in the F groups(P <0.05),the severity of POFS and gastrointestinal distension was significantly higher(P < 0.05),and the duration of POFS,gastrointestinal distension and abdominal pain was significantly longer(P < 0.05);The top three PDAEs in group F were POFS(38.62%),gastrointestinal distension(29.66%)and vertigo(25.52%).The risk factors for the occurrence of POFS in PGIE consultation in elderly frail patients were preoperative fatigue VAS score and pre-induction hypertension grade 3,and the protective factor was good sleep quality;the risk factor for the occurrence of gastrointestinal distension were long diagnosis,low qualification of endoscopists and treatment time and having exercise habits;the risk factor for the occurrence of vertigo was high ASA classification,and the protective factor was an appropriate increase in the mean dosage of propofol(mg/kg).Conclusion:1.Elderly patients experienced a variety of PDAEs such as POFS,gastrointestinal distention,dizziness,abdominal pain and headache after PGIE;In frail patients,the incidence of dizziness and headache was higher,gastrointestinal distention was more severe,and POFS,gastrointestinal distention and abdominal pain lasted longer.2.The top three incidence of PDAEs in frail patients were POFS,gastrointestinal distention and vertigo.3.Risk factors for the occurrence of POFS in PGIE consultations in elderly frail patients were high preoperative fatigue VAS score and pre-induction hypertension grade 3,and protective factor was good sleep quality.4.Risk factors for the occurrence of gastrointestinal distention in PGIE consultations in frail elderly patients are long consultation time,low qualification of endoscopistsand exercise habits.5.The risk factor for the occurrence of vertigo in PGIE consultations in elderly debilitated patients was high ASA grade,and the protective factor was an appropriate increase in the mean dosage of propofol(mg/kg).