Mount Carmel Health System Colorectal Surgery Fellowship Program Disclosures None Background Colorectal cancer CRC is the 2 nd most common cause of cancerrelated deaths in the US Colonoscopy is considered the gold standard for detection and excision of adenomatous polyps which are a pr ID: 601033
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Slide1
Feeling Rushed? Does Late Start Time Predict Poor Quality Colonoscopy?
Mount Carmel Health SystemColorectal Surgery Fellowship ProgramSlide2
Disclosures
NoneSlide3
Background
Colorectal cancer (CRC) is the 2nd most common cause of cancer-related deaths in the USColonoscopy is considered the gold standard for detection and excision of adenomatous polyps, which are a precursor to CRC
The ASGE/ACG task force has outlined multiple quality indicators for colonoscopy
Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin
2014;64:104–117
Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008;134:1570–1595Slide4
Background
Key Quality IndicatorsCecal intubation rate
95% in screening colonoscopies for normal healthy adults
Adenoma detection rate (ADR)
25% in men &
15% in women
Mean withdrawal time
6 minutes in patients with no polyps and intact anatomy
Slide5
Purpose of Study
Determine whether a delayed start time impacts the quality of colonoscopyAssess whether time of day or day of week impacts these quality indicatorsCompare and contrast adenoma detection rates among 8
endoscopists
6 Colorectal surgery teaching faculty
2 Community GastroenterologistsSlide6
Methods
Retrospective chart review of 746 patients who underwent screening colonoscopy from January 2016 – February 2016
Excluded patients with insufficient data or any patient that had a prior colon resection
Late start time defined as
15 minute difference between scheduled and actual start time
Multiple logistic regression used to determine association between late start time and quality indicators of colonoscopy
Slide7
Data Collected
Patient age and genderEndoscopistDate and day of the week of procedureScheduled start time
Actual start time
Cecal
intubation time
Withdrawal time
Number of polypectomies
Number of adenomas
Pathology dataSlide8
Results – Overall
692 patients met inclusion criteria344 males (49.7%) and 348 females (50.3%)
Median Age – 60
C
ecal
intubation rate – 98.6%
Mean adenoma detection rate – 39.6%
Mean withdrawal time – 10.6 minutes
99.0% rate
6 minutes Slide9
Results – Demographics / Endoscopist
ADR was associated with:Gender: Male - 49.2% vs Female - 30.2% (p <0.0001)
Mean Age: 57.7 vs 62.6 years old among patients without adenomas vs. patients with adenomas respectively (p<0.0001)
Endoscopist
: ADR ranged from 24% - 60% (p<0.0001)Slide10
Results – Quality Indicators
Quality Indicator
On Time
Delayed Start Time
p-Value
Cecal
Intubation
Rate
98.4%
98.7%
0.7609
Adenoma
Detection Rate
41.7%
37.5%
0.2750
Mean
Withdrawal time (SD)
10.6 (6.1)
minutes
10.5 (4.9) minutes
0.8956Slide11
Results – Other Factors
Analysis accounting for age, sex, and individual endoscopist found no association between ADR and:Delayed Start time (p=0.2701)
Case load for the day (p=0.8384)
Time of day (p=0.9345)
Day of week (0.5985)Slide12
Results by Endoscopist
p
<0.0001 for all parametersSlide13
Results – Endoscopists’ Late Start
vs. Withdrawal TimesSlide14
Results – Late Start vs. ADRSlide15
Conclusions
Delayed start time or other scheduling factors did not impact key quality indicators of colonoscopyCecal
intubation rate
95%
Adenoma detection rate males
25%, Females
15%
Mean withdrawal time
6 minutes
ADR varies by age, gender, and
endoscopist
as seen in other studies