P2402 - Wide Variability in Anesthesia Utilization for GI Endoscopic Procedures in the VA Healthcare System

Marianna Papademetriou, MD¹, Gobind Anand, MD², Heiko Pohl, MD³, Ali Ahmed, MD⁴, Violeta Popov, MD, PhD⁵, Henry Hefler, MD⁶, Gyanprakash Ketwaroo, MD⁷, Stephan Goebel, MD⁸, Andrew Gawron, MD, PhD⁹, Robert Zing, RN, BSN¹⁰, Jason A. Dominitz, MD, MHS¹¹, Fadi Antaki, MD^12
1Washington DC VA Medical Center, Washington, DC; ²University of California San Diego Health, San Diego, CA; ³Dartmouth Hitchcock Medical Center, White River Junction, VT; ⁴Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; ⁵NYU Langone Health, New York, NY; ⁶VA Southeast Louisiana Healthcare, New Orleans, LA; ⁷Yale Digestive Diseases and VA Connecticut Halthcare System, West Haven, CT; ⁸Atlanta VA Health Care System, Atlanta, GA; ⁹University of Utah Health, Salt Lake City, UT; ¹⁰University of Washington School of Medicine and VA Puget Sound Health Care System, Seattle, WA; ¹¹Veterans Health Administration, Bellevue, WA; ¹²John D. Dingell VA Medical Center, Detroit, MI

Introduction: The use of monitored anesthesia care (MAC) during routine GI endoscopy procedures has been increasing in the community over the past two decades. Within the Veterans Administration (VA), the use of MAC for elective esophagogastroduodenoscopy (EGD) and colonoscopy is highly variable. Criteria for use, availability and pre procedure work-up for MAC during routine elective outpatient GI procedures is not known. Understanding the utilization patterns of anesthesia in these procedures is essential for optimizing patient care and resource allocation. This study aims to investigate MAC utilization patterns in GI endoscopy across the national VA system.

Methods: A survey concerning MAC practices within VA was sent to the Gastroenterology Section Chiefs and endoscopy unit directors, with a request for one survey per site. The survey assessed the frequency of MAC utilization for routine EGD and colonoscopy, as well as the perioperative workup required. Descriptive statistics were used to analyze the data including frequencies and percentages of responses.

Results: Surveys were received from 120 of 148 eligible VA facilities (81.0%). 114 of these sites (95%) have access to anesthesia services for routine endoscopy. There was wide variability in MAC use (Figure 1), with 24% reporting MAC use for all procedures and 71% reporting varying proportions of MAC vs moderate sedation use. Pre-procedure anesthesia evaluation also varied: 49 sites (42.9%) required pre-procedure bloodwork; 41 sites (40.0%) require pre-procedure EKGs; 15 sites (13.2%) required pre-procedure chest x-ray. At 86 sites (75.4%), pre-procedure evaluation was performed prior to the procedure day. Overall, 64 sites (53.3%) were either satisfied or very satisfied with their access to anesthesia services, and 36 sites (30%) were dissatisfied or very dissatisfied.

Discussion: Our study highlights the variability in anesthesia utilization and practice patterns for routine GI endoscopic procedures within the VA healthcare system. This variability provides an opportunity for standardization of practices to help improve patient access, reduce routine pre procedure testing, and promote appropriate use of MAC for GI endoscopy.




Disclosures:


Marianna Papademetriou, MD¹, Gobind Anand, MD², Heiko Pohl, MD³, Ali Ahmed, MD⁴, Violeta Popov, MD, PhD⁵, Henry Hefler, MD⁶, Gyanprakash Ketwaroo, MD⁷, Stephan Goebel, MD⁸, Andrew Gawron, MD, PhD⁹, Robert Zing, RN, BSN¹⁰, Jason A. Dominitz, MD, MHS¹¹, Fadi Antaki, MD¹². P2402 - Wide Variability in Anesthesia Utilization for GI Endoscopic Procedures in the VA Healthcare System, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.