Do indication and demographics for colonoscopy affect completion? A large national database evaluation

Abstract

Background and aim Indication for colonoscopy has not been examined as a predictor of colonoscopy completion. We hypothesized that colonoscopy conducted for colorectal cancer screening might have higher in completion rates than colonoscopy conducted for other indications. Methods The study design was a retrospective cohort. Colonoscopies recorded within the Clinical Outcomes Research Initiative database conducted between 1 January 2002 and 30 June 2003 were analyzed. Indication included: average-risk screening; surveillance; nonspecific abdominal symptoms; bleeding symptoms; or family history of colorectal carcinoma. Demographic factors and indication for colonoscopy were evaluated for the outcome of incomplete colonoscopy using logistic regression analysis. Results 129,549 Colonoscopy procedures were analyzed. Average risk screening seemed to be protective for completion (relative risk: 0.69; 95% confidence interval: 0.63–0.75). Bleeding and nonspecific symptoms had higher risk of incomplete procedure compared to other indications. Males had higher completion rates compared to females (relative risk: 0.62; 95% confidence interval: 0.58–0.66). Community setting had higher completion rates compared to academic or Veteran’s administration sites. Increasing age was associated with higher rate of incomplete colonoscopy. Conclusion Colonoscopy conducted for screening indication has comparable completion rates when compared with other indications. An overall completion rate of around 95% was noted in this study. This is the largest study to date verifying that completion rates are meeting recommended multisociety guidelines in the USA. Nonspecific abdominal symptoms in Caucasian population, female sex, advanced age, clinical setting, and ethnic groups African–American and Hispanic were found to have increased risk of incomplete procedure.

Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

“…We did not investigate certain variables that may be associated with non-attendance, including socio-economic status, ethnicity, indication for colonoscopy, colonoscopy referral source, or patient-specific barriers to attendance. 10,14,16,25,32 Furthermore, because few patients in this study were uninsured, on Medicaid, or lacked college education, our findings may not extend to these populations. Likewise, because the NAR relies on data from prior interactions with a health system, it may have limited utility for predicting adherence for patients who are new to a health system, or rarely see a physician.…”

“…A number of studies have identified predictors of non-adherence with colonoscopy scheduling and completion. [9][10][11][13][14][15][16][17] However, no study has described a validated multivariable model for predicting non-adherence with scheduled colonoscopy. Furthermore, no automated method to assess a patient's prior record of nonadherence has been developed, an essential step for any implementation strategy involving large patient populations.…”

Variation in caecal intubation rates between screening and symptomatic patients

“…Recognised factors that can impair the CIR include: increasing patient age, [5][6][7] female gender, 6,7 poor bowel preparation, 8,9 presence of diverticulosis 5,9 and obstructing tumours. 9 Our results have confirmed the importance of female gender, poor bowel preparation and the presence of tumours; however, we did not demonstrate any significant differences in the proportions of patients with these factors, between the screening and symptomatic groups of patients.…”

“…irrespective of any pathology encountered. 3,4 Several factors have been identified that can impair the CIR, including: increasing patient age, [5][6][7] female gender, 6,7 poor bowel preparation, 8,9 presence of diverticulosis 5,9 and obstructing tumours. 9 Symptomatic patients may have different characteristics compared to asymptomatic individuals undergoing colonoscopy for colorectal cancer screening.…”

“…7,12 The aim of this study was to compare colonoscopists' performance, as assessed by CIR in symptomatic patients compared to individuals undergoing colonoscopy for colorectal cancer screening.…”