Abstract
BACKGROUND: Screening colonoscopy harm data are limited for adults ages 76 to 85 years. METHODS: We conducted a retrospective cohort study of screening colonoscopies versus fecal immunochemical tests (FIT) and general population matched comparators ages 76 to 85 years within three integrated healthcare systems (2010-2019). The primary outcome was death or overnight hospitalization within 30 days. A secondary outcome also included nine harm diagnoses. Adjusted risk estimates and risk differences (RD) were obtained using Poisson regression. Narrow analyses excluded outcomes after the next lower endoscopy or colorectal procedure, whereas broad analyses included them. RESULTS: Patients undergoing screening colonoscopy (N = 4,435) had a higher 10-day cumulative incidence of gastrointestinal bleeding {0.18% [95% confidence interval (CI), 0.09%-0.35%]} and perforation [0.09% (95% CI, 0.03%-0.23%)] than those with FIT (N = 17,740) and the general population (N = 44,350) in the narrow analysis. Screening colonoscopy patients had a 1.04% (95% CI, 0.74%-1.34%) risk of death or hospitalization within 30 days in the narrow analysis, similar to those with FIT [RD = 0% (95% CI, -0.36% to 0.35%)] and the general population [RD = -0.07% (95% CI, -0.39% to 0.25%)]. In the broad analysis, risk following colonoscopy was 2.30% (95% CI, 1.85%-2.75%) with RD = 1.13% (95% CI, 0.67%-1.60%) versus general population [ages 76-80 years: RD = 0.93% (95% CI, 0.45%-1.41%) and ages 81-85 years: RD = 2.14% (95% CI, 0.74%-3.54%)]. Secondary outcomes followed a similar pattern by age. CONCLUSIONS: At ages 76 to 85 years, screening colonoscopies including downstream procedures are associated with an increased short-term risk of death or hospitalization. IMPACT: Harm data can be combined with benefit data to guide screening colonoscopy decisions among older adults.