Frequency and Indications for Performance of Repeat Colonoscopy within Sixty Days

Abstract

Listen

Translate article

Purpose: Overuse of colonoscopy affects the availability, quality, and cost of care. We sought to evaluate the frequency and indications for repeat colonoscopy within 60 days, and to evaluate whether baseline patient characteristics or the course during the first colonoscopy predicted the need for repeat procedures. Methods: We identified 781 patients who had more than one colonoscopy within 60 days, among 51559 patients (1.5%) who underwent colonoscopy during Jan 2004 to Dec 2006. Control patients who did not have repeat exams were matched with the study population with respect to procedure date and location. Medical records were reviewed for patient demographic and historical data and numerous procedural characteristics. Univariate and multivariate logistic regressions were performed to assess the association between the repeat colonoscopy and patient age, gender, BMI, history of abdominal surgery, procedure tolerance, size of largest polyp, endoscopist experience, inpatient vs. outpatient status, and use of anticoagulants, narcotics or benzodiazepines. Results: The most common reasons for repeat colonoscopy included poor bowel preparation (32%), “Need for Complex Therapy” (21%), bleeding management (13%), pathology follow-up (12%), stricture therapy (6%), failure due to intolerance (4%), failure due to anatomy (4%), and anticoagulant or antiplatelet agent mgmt (2%). Multivariate logistic regression showed statistically significant differences between the study and control populations in regard to age (OR = 1.01; 95% CI 1.003–1.017; P < 0.005), history of abdominal surgery (OR = 1.68; 95% CI 1.34–2.11; P < 0.0001), procedural tolerance level (OR = 4.01; 95% CI 2.20–7.30; P < 0.0001), inpatient versus outpatient status (OR = 1.78; 95% CI 1.31–2.41; P < 0.001), largest polyp size ≥ 2 cm (OR = 10.70; 95% CI 5.08–22.56; P < 0.0001), and use of anticoagulants (OR = 1.58; 95% CI 1.12–2.22; P < 0001). Endoscopist experience, and patient gender, BMI, or use of narcotics or benzodiazepines did not correlate with repeat procedures. Conclusion: Poor bowel preparation and referral for complex therapies are the dominant indications for repeating colonoscopy within 2 months. Variables associated with performance of repeat colonoscopy included older age, history of previous abdominal surgery, inpatient status, poor procedure tolerance, largest polyp size more than 2 cm, and use of anticoagulants at the time of the first colonoscopy.