156 Predictive Factors for Inadequate Inpatient Bowel Preparation

Abstract

INTRODUCTION: Colonoscopy is highly sensitive for the detection of precancerous polyps and for the visualization of the entire colon during colorectal screening. Inpatient colonoscopies pose a special risk of poor preparation. We reviewed bowel preparation methods and patient factors to identify predictors of inadequate bowel preparation for inpatient colonoscopy at our institution. METHODS: All patients ages older than 18 years of age undergoing inpatient colonoscopy in 2017–2018 were reviewed. The primary outcome was inadequate bowel preparation and secondary outcomes were successful cecal intubation, duration of colonoscopy, and hospital LOS. Outcomes were compared according to demographic characteristics, comorbidities, abdominal surgery, and medications using multivariable regression with stepwise covariate selection. Statistical significance was set at P < 0.05. RESULTS: The analysis included 315 patients (median age = 67 years; 45% female, Table 1). The majority of colonoscopies were performed for anemia (78%). Visualization was deemed adequate in 56%, fair in 27%, and poor in 17% of cases. Cecal intubation was successful in 84% of cases. The median duration of colonoscopy was 25 min and LOS was 2 days. Unsuccessful cecal intubation was most likely with poor visualization (36% vs 11%, P = 0.014). There was no increased colonoscopy duration with poor visualization (P = 0.075). There was no significant LOS with worse visualization quality (P = 0.185). Factors predicting worse visualization quality included older age, history of CHF, cirrhosis, and motility disorders (Table 2). Older age, COPD, and colonoscopy performed for other indications were associated with unsuccessful cecal intubation. Factors predicting prolonged LOS included several comorbidities and usage of iron or neuromodulators (Table 3). CONCLUSION: At our institution, patients who were older or had significant co-morbid conditions (CAD, CHF, COPD, motility disorders, or cirrhosis) were more likely to have inadequate inpatient bowel preparation. Other studies found similar findings in patients with diabetes, cirrhosis, history of stroke or TCA use. Bowel preparation type did not affect the duration, quality of visualization, or the success of cecal intubation. Further work is needed to optimize inpatient bowel preparation protocols in older patients with multiple co-morbidities. Future studies should evaluate the success of bowel preparation in inpatient setting with a standardized bowel preparation score like the Boston Bowel Prep score.