Abstract
Introduction: Proximal Serrated Polyp Detection Rate (PSP-DR) has been shown to correlate with Adenoma Detection Rate (ADR), which is a common quality indicator for effectiveness of colonoscopy. The time of day for colonoscopy and its effect specifically on PSP-DR has not been rigorously studied. We examine differences in PSP-DR and ADR of colonoscopy performed in the morning vs. afternoon. Methods: We retrospectively obtained endoscopy and pathology data from average-risk screening colonoscopy performed at a large healthcare system with six endoscopy labs from Jan 2014 - May 2015. These dates reflect standardized pathology nomenclature to accurately capture PSP-DR. Diagnostic, surveillance, and high-risk screening colonoscopy was excluded from the analysis. A previously validated natural language processing tool was used to determine polyp location and histology (adenoma, sessile serrated polyp, hyperplastic polyp). ADR and PSP-DR were calculated for each endoscopist, with a minimum of 100 colonoscopies performed during the study period. Morning colonoscopy was defined as insertion start time before 12:00PM and afternoon colonoscopies as those that started after 12:00PM. Results: 26,153 total colonoscopy exams were performed by 24 Gastroenterologists, of which 9,987 were screening colonoscopies. Mean ± SD age for the patient population was 60.1 ± 1.7, of which 45.9% were male. 81.2% of procedures were performed in the morning. Characteristics including age, gender, cecal intubation and bowel prep was similar between morning and afternoon cases. Endoscopist insertion (time to cecum) and withdrawal times (time from cecum) were similar as well. Withdrawal time was calculated from colonoscopies in which no polyps were resected. (Table 1) Amongst each individual gastroenterologist, the average rate (95% CI) of PSP-DR was 10.3 (9.7 - 10.9) and ADR was 36.3 (35.3 - 37.2). Rates for AM and PM exams did not differ from each other or the total population. (Table 2).Table 1a: Patient Characteristics and Procedure Times (*Calculated with 4876 Normal Colonoscopies)Table 1b: Individual Endoscopist Detection Rate Averages (95% CI)Conclusion: In our large community-based cohort, our endoscopists surpassed suggested benchmarks for both ADR and PSP-DR, and their performance did not differ between morning and afternoon procedures. Our results accounted for insertion and withdrawal times, population characteristics, and prep quality. These findings suggest that greater lab utilization in the afternoon can be considered without loss of high quality outcomes.
Published Version
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