Background and AimsThe 2020 United States Multi-Society Task Force on Colorectal Cancer guidelines for surveillance after colonoscopy with polypectomy introduced significant changes in surveillance intervals. We sought to identify rates of adherence to these new guidelines at an academic medical center. MethodsAverage-risk screening colonoscopies where 1-4 polyps <10 mm were removed between 1/1/2020 and 6/30/21 were included. To determine predictors of non-adherence, a multivariable logistic regression analysis was conducted and included patient and procedure-related variables. Bayesian changepoint analysis was applied to identify timing of change in adherence. Multinomial logistic regression was used to identify predictors of variability within the guidelines. Results1,026 procedures were analyzed. Adherence to the guidelines was 85%. In procedures with 1-2 polyps, increasing size (OR 0.84 per mm; 95% CI: 0.75 - 0.93) and a mixture of tubular adenomas (TA) and hyperplastic polyps (HP) (OR 0.35; 95% CI: 0.21 - 0.59) were associated with non-adherence. Among procedures with 1-2 TAs, age (OR 0.86 per 5-year increase; 95% CI: 0.75 - 0.99), increasing size (OR 0.86 per mm; 95% CI: 0.75 - 0.99) and polyp number (OR 0.54; 95% CI: 0.33-0.90) were associated with non-adherence. Changepoint analysis identified a potential changepoint on 2/9/20 (95% credible interval 2/4/2020-2/22/2020). Larger TAs were less likely to receive a 10 year recommendation (OR 0.61, 95% CI 0.5 – 0.75). ConclusionAdherence rates to the 2020 surveillance guidelines were high with a potential changepoint identified on 2/9/20. Deviation from guidelines was associated with patient and procedure related variables.