Dawn Meehan, a teacher's assistant and writer, stands in her classroom on March 16 at Gotha Middle School in Windermere, Fla. Meehan, 42, had a colonoscopy in February, under deep sedation monitored by an anesthesia specialist.
CHICAGO — Few people want to be wide awake during their colonoscopy, but new research suggests too many are getting extra sedation, costing as much as $1 billion yearly in potentially needless services.
Use of anesthesiologists to monitor sedation during colonoscopies and other digestive imaging tests has more than doubled in recent years, and they’re used most often for low-risk patients who typically don’t need the extra help, the study authors said.
“These services are not harming patients. They’re basically giving them a luxury that is not strictly necessary,” said the study’s lead author, Dr. Soeren Mattke.
Patients usually are briefly sedated for a colonoscopy, with some of those sedations requiring specialists. That includes use of propofol, a powerful intravenous drug that can cause deep sedation.
Anesthesiologist-monitored sedation, with or without propofol, is recommended for high-risk patients, including those who are old, sick or previously had complications with anesthesia.
While propofol sedation is also sometimes given to low-risk colonoscopy patients, the study authors suggest that’s often unnecessary.
Drugs usually recommended for these patients typically cause lighter sedation, though most patients don’t remember anything about the exams afterward. These drugs can be given by the doctor doing the exam, but the study suggests they’re often being given and monitored by anesthesiologists.
The researchers analyzed insurance claims data on more than 6 million U.S. adults who had exams of the upper digestive tract between 2003 and 2009. When the study began, 14 percent of tests included an anesthesiologist. That climbed to more than 30 percent by 2009.
The extra treatment added an average of about $500 to an insured patient’s bill in 2009, and $150 to a Medicare bill. In 2009, about 3 million colonoscopies and other digestive scoping tests were done, including anesthesia services, amounting to $1 billion, the study authors estimated.
Low-risk patients undergoing colonoscopies and other digestive scoping exams sometimes request propofol because they want to be totally unconscious and have heard that it wears off quickly, unlike other sedatives, said Dr. John Vargo, a spokesman for the American Society for Gastrointestinal Endoscopy and a digestive specialist at the Cleveland Clinic.
Propofol requires careful monitoring because it has “a narrow window between providing deep sedation and making people stop breathing,” and unlike other sedatives, there’s no rescue drug to reverse its effects, said Dr. Norm Cohen, vice president for professional affairs at the American Society of Anesthesiologists.
Doctors who do the exams can be trained to use propofol in healthy patients, but a journal editorial said some prefer anesthesiologist assistance because it allows them to focus on the exam, and if something goes wrong, they may not be held accountable, Vargo said.
Dawn Meehan, 42, an Orlando, Fla.-area teacher’s assistant, had a colonoscopy last month under deep sedation monitored by an anesthesia specialist; her insurance covered everything.
Even though the extra sedation is more costly, Meehan said patients who want it should get it, because otherwise some might “shy away from getting screened.”