Effect of Colonoscopy Volume On Quality Indicators

M Lougheed, D Pace, M Borgaonkar, C Marcoux, B Evans, D Boone, J McGrath. Memorial University, Faculty of Medicine, St. John’s, NL

Introduction: The objective of this study is to determine if colonoscopy quality is associated with the annual case volume of endoscopists.

Methods: A retrospective cohort study was performed on 3235 patients who underwent colonoscopy in the city of St. John's, NL between January and June 2012. Using the electronic medical record system, including the endoscopy procedure report, the nursing record of the endoscopy, and the pathology report, data on subjects were collected on completion of colonoscopy, polyp detection and adenoma detection rates. SPSS was used for analysis. Endoscopists were divided into quintiles based on annual case volume (1st 0-149; 2nd 150-249; 3rd 250-301, 4th 302-530, 5th >530). Chi-squared tests were performed to assess differences in cecal cannulation, polyp detection, and adenoma detection among the five groups.

Results: Mean age was 58.4 years with 55.8% of the group being female. A total of 13 surgeons and 8 gastroenterologists were studied. There was a significant difference in completion of colonoscopy based on annual volume (80.7% in the 1st quintile to 93.3% complete in the 5th quintile, p<0.001). Polyp detection rates increased with higher annual case volume (1st quintile 25.1%; 2nd quintile 25.7%. 3rd quintile 30.4%, 4th quintile 39.5%, 5th quintile 40.9%; p<0.001). Adenoma detection rates were also higher for the endoscopists with the highest case volumes ( 1st quintile 16.0%; 2nd quintile 16.1%. 3rd quintile 19.5%, 4th quintile 20.1%, 5th quintile 23.7%; p<0.001).

Conclusion: Higher annual case volume is associated with better quality of colonoscopy in terms of completion, polyp detection, and adenoma detection.

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