1. Feeling Rushed? Does Late Start Time Predict Poor Quality Colonoscopy?
Mount Carmel Health System
Colorectal Surgery Fellowship Program

2. Disclosures
None

3. Background
Colorectal cancer (CRC) is the 2nd most common cause of cancer-related deaths in the US
Colonoscopy is considered the gold standard for detection and excision of adenomatous polyps, which are a precursor to CRC
The ASGE/ACG task force has outlined multiple quality indicators for colonoscopy
Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, CA Cancer J Clin 2014;64:104–117
Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008;134:1570–1595

4. Background Key Quality Indicators
Cecal intubation rate ≥ 95% in screening colonoscopies for normal healthy adults
Adenoma detection rate (ADR) ≥ 25% in men & ≥ 15% in women
Mean withdrawal time ≥ 6 minutes in patients with no polyps and intact anatomy
Some of the key quality indicators are …

5. Purpose of Study
Determine whether a delayed start time impacts the quality of colonoscopy
Assess whether time of day or day of week impacts these quality indicators
Compare and contrast adenoma detection rates among 8 endoscopists
6 Colorectal surgery teaching faculty
2 Community Gastroenterologists
Make sure you describe busy endoscopists at an ASC that does not tolerate delays well. Open only until 5pm. Perform approximately 5,000 endoscopies per year.

6. Methods
Retrospective chart review of 746 patients who underwent screening colonoscopy from January 2016 – February 2016
Excluded patients with insufficient data or any patient that had a prior colon resection
Late start time defined as ≥ 15 minute difference between scheduled and actual start time
Multiple logistic regression used to determine association between late start time and quality indicators of colonoscopy

7. Data Collected Patient age and gender Endoscopist
Date and day of the week of procedure
Scheduled start time
Actual start time
Cecal intubation time
Withdrawal time
Number of polypectomies
Number of adenomas
Pathology data

8. Results – Overall 692 patients met inclusion criteria
344 males (49.7%) and 348 females (50.3%)
Median Age – 60
Cecal intubation rate – 98.6%
Mean adenoma detection rate – 39.6%
Mean withdrawal time – 10.6 minutes
99.0% rate ≥ 6 minutes

9. Results – Demographics / Endoscopist
ADR was associated with:
Gender: Male % vs Female % (p <0.0001)
Mean Age: 57.7 vs 62.6 years old among patients without adenomas vs. patients with adenomas respectively (p<0.0001)
Endoscopist: ADR ranged from 24% - 60% (p<0.0001)

10. Results – Quality Indicators
On Time
Delayed Start Time
p-Value
Cecal Intubation Rate
98.4%
98.7%
0.7609
Adenoma Detection Rate
41.7%
37.5%
0.2750
Mean Withdrawal time (SD)
10.6 (6.1) minutes
10.5 (4.9) minutes
0.8956

11. Results – Other Factors
Analysis accounting for age, sex, and individual endoscopist found no association between ADR and:
Delayed Start time (p=0.2701)
Case load for the day (p=0.8384)
Time of day (p=0.9345)
Day of week (0.5985)

12. Results by Endoscopist
p< for all parameters

13. Results – Endoscopists’ Late Start vs. Withdrawal Times

14. Results – Late Start vs. ADR

15. Conclusions
Delayed start time or other scheduling factors did not impact key quality indicators of colonoscopy
Cecal intubation rate ≥ 95%
Adenoma detection rate males ≥ 25%, Females ≥ 15%
Mean withdrawal time ≥ 6 minutes
ADR varies by age, gender, and endoscopist as seen in other studies