187 Poor Bowel Prep Leads to Low Yield for Inpatient Colonoscopies and Significantly Increases Overall Healthcare Cost: It Is High Time to Reevaluate Bowel Prep Options

Abstract

INTRODUCTION: There have been multiple studies reporting inadequate bowel preparation based on standardized scales like Boston bowel preparation scale (BBPS) for inpatients compared to outpatient colonoscopies. Most of these inpatient procedures might be incomplete or inadequate due to bowel prep and they might be repeated the next day putting additional burden on both the patient and hospital financial system or repeated as outpatient. Aim of this study to evaluate retrospectively the efficacy of bowel prep on inpatient colonoscopy and indirectly assess healthcare delivery cost at our institution. METHODS: Prospectively collected data for all inpatient colonoscopies done at our center between January 2018 to August 2018 was retrospectively evaluated. All patient's scheduled for inpatient colonoscopy was given split dose bowel preparation according to standard guidelines. Our database included daily endoscopy and floor nurse documentation regarding completeness of bowel prep, procedure cancellation or rescheduling related to poor bowel prep and colonoscopy procedure detail including Boston Bowel Prep Score for each completed procedure. Adequate bowel preparation is consider composite BBPS 7 or above and BBPS 6 or less was considered inadequate bowel prep. RESULTS: A total of 246 (n = 246) patients were scheduled for inpatient colonoscopy from January 2018 to August 2018. Of the total patients about 136 (55.5%) patients were male and 110 (44.5%) patients were female with average age of 60.6 ± 16.15 years (Range 18–91 years). Of the total number of patients (200) who completed their procedures, a total of 114 (57.0%) patients had a total score (BBPS Right + BBPS Transverse + BBPS Left) of 7 and above and the rest 86 (43%) patients had a BBPS score of less than 7. For all these patients, a repeat colonoscopy at short interval (within 6 months–1 year) was recommended. Average cost of additional inpatient hospitalization day at our institution is at least 600$. Indirect cost with loss of overall productivity was estimated to be additional 1000$. This each inpatient colonoscopy with poor bowel prep added at least 1600$ in direct and indirect healthcare cost, not counting indirect cost incurred by patient and family members related to loss of productivity. CONCLUSION: While colonoscopy remains valuable diagnostic and therapeutic tool, current bowel prep options for inpatient colonoscopy are not sufficient. Alternative means of bowel prep options needs to evaluated in inpatient setting.