Comparing Colonoscopy Quality Indicators between Surgeons and Gastroenterologists in A Rural Healthcare System

Abstract

Background: There is a significant shortage of physicians providing colonoscopies, especially in underserved and rural areas. Surgeons are increasingly filling this role by providing endoscopy services including colonoscopy in these areas. As a result, there has been discussion regarding the quality of colonoscopies performed by different provider specialties, specifically for non-gastroenterologists. The purpose of this study was to compare colonoscopy quality measures between gastroenterologists and surgeons in a rural central New York healthcare system. Methods: All colonoscopies performed by 23 endoscopists, 14 surgeons and 9 gastroenterologists, within a rural healthcare network in 2017 were included as samples within this study, totaling 6265 colonoscopies. These included all diagnostic, screening, and surveillance colonoscopies. Quality metrics including withdrawal times and adenoma detection rates were calculated for all providers and the two groups were statistically analyzed and compared using chi-squared testing. Results: 3113 colonoscopies were performed by surgeons (average of 222 per provider) and 3159 were performed by gastroenterologists (average of 351 per provider). Adenoma detection rates for surgeons and gastroenterologists were essentially the same at 31.38% and 31.82%, respectively (p=0.6882). Withdrawal times were slightly longer for surgeons at 13.19 minutes versus 11.02 minutes for gastroenterologists, though this difference was not statistically significant (0.2985). Conclusions: Our results show that surgeons are not inferior to gastroenterologists in performing colonoscopies using the quality metrics of adenoma detection rates and withdrawal times. With the ongoing shortage of endoscopists, surgeons may be able to alleviate some of the burden without reduction in quality.