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

Disclosures None

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, 2014. 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

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 …

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.

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

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

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

Results – Demographics / Endoscopist ADR was associated with: Gender: Male - 49.2% vs Female - 30.2% (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)

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

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)

Results by Endoscopist p<0.0001 for all parameters

Results – Endoscopists’ Late Start vs. Withdrawal Times

Results – Late Start vs. ADR

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