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Research Letter
March 2017

National Trends in Use of Monitored Anesthesia Care for Outpatient Gastrointestinal Endoscopy in the Veterans Health Administration

Author Affiliations
  • 1Center for Clinical Management Research, Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
  • 2Department of Internal Medicine, University of Michigan Health System, Ann Arbor
  • 3Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, Washington
  • 4Division of Gastroenterology, University of Washington School of Medicine, Seattle
JAMA Intern Med. 2017;177(3):436-438. doi:10.1001/jamainternmed.2016.8566

Historically, sedation for routine gastrointestinal (GI) endoscopy has been directed by the endoscopist (generally with short-acting opioids and benzodiazepines). In recent years, use of monitored anesthesia care (MAC) for GI endoscopy has been increasing, with rates increasing to 47.6% and 53.0%, respectively, in Medicare and commercially insured patients in 2013.1 Monitored anesthesia care requires the presence of an anesthesiology professional and typically involves administration of propofol, leading to a deeper level of sedation. It is estimated that use of MAC for esophagogastroduodenoscopy (EGD) and colonoscopy resulted in additional national expenditures of more than $1 billion for Medicare and commercially insured patients in 20092 and is associated with higher rates of 30-day endoscopy-related complications compared with standard sedation.3 Current guidelines recommend considering MAC for patients with anticipated intolerance of standard sedatives or certain comorbidities, but caution that MAC is not cost-effective for average-risk patients undergoing routine procedures.4 Yet, more than half of MAC appears to be used for routine endoscopy in low-risk patients, suggesting widespread guideline-discordant use that may in part be driven by financial incentives.1

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