Predicting propofol requirements in advanced gastrointestinal endoscopy: a validated model incorporating age and comorbidity index.

BACKGROUND

Propofol requirements during advanced gastrointestinal endoscopy vary substantially among patients with multimorbidity, and the influence of comorbidity burden remains incompletely characterized. This study aimed to evaluate the association between Charlson Comorbidity Index (CCI), age-adjusted CCI (ACCI), and propofol requirement, and to develop a model for individualized sedation.

METHODS

This retrospective cohort study included 1,555 adult patients undergoing advanced gastrointestinal endoscopy (primarily endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography) under bispectral index (BIS)-guided target-controlled infusion (TCI) propofol sedation at a tertiary referral center between 2017 and 2023. The primary outcome was the lean body mass (LBM)-adjusted propofol infusion rate. Patients were classified into higher- and lower-propofol requirement groups for logistic regression analyses, and sensitivity analyses were performed using the continuous outcome variable. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC) with internal split-sample validation.

RESULTS

Older age, male sex, longer procedure duration, and higher CCI were independently associated with a lower probability of higher propofol requirement in multivariable analysis. Sensitivity analyses using the continuous LBM-adjusted propofol infusion rate yielded consistent findings. The model demonstrated good discrimination in both the training cohort (AUC 0.831, 95% CI 0.808-0.853) and validation cohort (AUC 0.841, 95% CI 0.780-0.882).

CONCLUSIONS

Older age, male sex, and higher comorbidity burden were independently associated with lower relative propofol requirements during advanced gastrointestinal endoscopy under BIS-guided TCI sedation. The proposed model demonstrated acceptable discrimination; however, external validation is required before clinical application.