Colonoscopy Key Performance Indicators in a Rural General Australian Hospital

Abstract

We evaluated colonoscopic neoplastic yield (adenomas and cancers) in a rural endoscopic unit alongside several key performance indicators known to influence yield. A second aim was to compare neoplastic yield according to colonoscopic indication.Methods - We retrospectively audited 371 colonoscopies (163 male, 208 female) undertaken over six months (2007-2008) at the Mersey Hospital, Tasmania.ResultsCaecal intubation rate was 86.79% (males 90.8%, females 83.65%); bowel preparation judged as good (56.87%), fair (22.37%), poor (13.48%), not recorded (7.28%). Adenoma Detection Rate (ADR) was 11.86% (males 18.4%, females 6.7%). Inclusion of cancers - Significant Neoplastic Lesion Rate (SNL) was 15.9% (males 20.86%, females 12.02%). Mean withdrawal time to anus was 5.76 minutes with significantly higher ADR for 6-10, 11-15 and >15 minutes than 0-5 minutes (p<0.0001).SNL detection rates for major presenting indications were expressed as number needed to screen (NNS) with 95% confidence intervals (CI). Results: PR bleeding, NNS = 5, CI 3.45-7.69; Anaemia, NNS = 9.5, CI = 4-25; Abdominal Pain, NNS = 12.76, CI 5.26-33; Change in bowel habit, NNS = 6, CI 3.33-12.5; Family history colorectal cancer, NNS = 4.83, CI 3.03-8.33; Positive Faecal Occult Blood, NNS = 4.26, CI = 2.94-6.67, without significant sex differences amongst groups (p=0.5186)ConclusionsADR fell short of benchmark standards (25% males, 15% females); with slightly lower than recommended caecal intubation rate (e90%). Adequacy of bowel preparation was comparable to reference ranges. A statistically-significant trend between rapid withdrawal times and lower ADR was found, although caution should be exercised in interpretation.