Assessing Quality Metrics for Screening Colonoscopies at a Community Hospital in New Jersey: A Single Center Observational Study

Abstract

Introduction: Numerous quality metrics exist to evaluate screening colonoscopies. American Society for Gastrointestinal Endoscopy (ASGE) recommends an adenoma detection rate (ADR) of 25% for male patients and 15% for women patients undergoing screening colonoscopies; additional recommendations are a cecal intubation rate of 95% and cecal withdrawal time of 6 minutes. As per our literature review, there is limited evidence about the quality of screening colonoscopies at community hospitals. Our study is the first community hospital in New Jersey to assess the quality of our screening colonoscopy program. Methods: Between August 2016 and April 2017, ten board-certified endoscopists performed 1087 screening colonoscopies at our community hospital, University Medical Center of Princeton at Plainsboro. We excluded diagnostic and surveillance exams, as well as those in which the patient had undergone a colon resection. Our primary outcome was to retrospectively assess whether our community hospital met ASGE recommendations. ADR is defined as the number of colonoscopies during which at least one adenoma is found (confirmed by pathology) divided by the total number of colonoscopies. Gender and age of patient, quality of preparation, cecal intubation as identified by the ileocecal valve and appendiceal orifice, cecal withdrawal time and adenoma detection rate were all recorded. Results: 1087 screening colonoscopies were included in our study. The mean age of those screened was 56.2 (SD 8.3); 48.7% of patients were between the age of 50-59 and 40.1% of patients were between the age of 60-69. 505 patients were males (46.5%) and 582 patients were women (53.5%). Three of our endoscopists were women: the distribution of their patients that were women was 76.41%, 71.6% and 67%. Our mean cohort ADR was 36.6%(range 13%-61%); it was 39.2% for male patients and 34.3% for women patients. Our mean cecal withdrawal time was 12.39 minutes (range 8.9-25.98 minutes). Our cecal intubation rate was 99.3%.Figure: contains aggregate data about our screening program. Individual endoscopists are listed in the left column. Cumulative data is presented in the last row.Table: Table. Demographics of Our Screening Colonoscopy ProgramTable: Table. Our community hospital far exceeded the recommended quality metrics of the American Society for Gastrointestinal Endoscopy (ASGE) for screening colonoscopiesConclusion: Our community hospital cohort far exceeded the recommendations of the ASGE in terms of ADR, cecal intubation rate and cecal withdrawal time. Our three women endoscopists performed majority of their screening colonoscopies on women patients suggesting a possible gender preference of women patients wanting women endoscopists. There was significant variability in the ADR amongst our endoscopists; given similar patient population in terms of age and gender, this suggests that ADR is greatly endoscopist-dependent.