Colonoscopy Quality Metrics – A Performance Review of Colorectal Surgeons

Jacquelyn M Charbel, DO, Kevin C Long, MD, Amir L Bastawrous, MD, Rodney Kratz, MD, Darren Pollock, MD, Raman Menon, MD, Melinda Hawkins, MD, Daniel Froese, MD. Swedish Hospital

Introduction: Quality metrics for colonoscopy are commonly referenced when defining competence among endoscopists. Colonoscopy is a skill set practiced by many different specialists ranging from family practitioners to colorectal surgeons. A retrospective review from the Canadian health system database published in 2011 detailed colonoscopic quality metrics of gastroenterologists, general surgeons, and general practitioners. The study suggested that non-gastroenterologists did not perform as well as gastroenterologists, but did not include quality metrics from colorectal surgeons. The Canadian heath system review concluded that a polyp detection rate of > 30% leads to a significant decrease of proximal colorectal cancer development within 3 years of the colonoscopy (1).

Methods: In this study, our goal is to assess quality measures including polyp detection rate of a group of colorectal surgeons performing colonoscopy. We reviewed colonoscopic procedural data from the Swedish Colon and Rectal Surgery Clinic at Swedish Medical Center in Seattle, Washington. A total of 748 charts were reviewed from November 2013 to June 2014. The endpoints reviewed include polyp detection rate, overall adenoma detection rate (male and female), and sessile serrated adenoma detection rate (male and female). Quantitative metrics were collected to assess endpoints such as cecal intubation rate and time, as well as scope withdrawal time.

Results: The results for the colorectal surgeons reveal an overall polyp detection rate of 55.88% (49.11% female, 61.17% male), overall adenoma detection rate of 38.88% (27.47% female, 50.12% male), and overall sessile serrated adenoma detection rate of 9.54% (7.41% female, 10.72% male).

Quantitative metrics for the colorectal surgeons revealed a 99.5% cecal intubation rate with an average cecal intubation time of 8.18 minutes. The average recorded withdrawal time of a colonoscopy in which no polypectomy was performed was 8.99 minutes, as recorded by the endoscopy support staff in the electronic medical record. Average recorded withdrawal time of a colonoscopy in which 1 or more polypectomies were performed was 16.05 minutes.

Discussion: The national standard set by the American College of Gastroenterology (ACG) of 25% adenoma detection rate in men and 15% adenoma detection rate in women is significantly lower than the percentages achieved by the colorectal surgical group (5). Regarding quantitative recommendations, multiple studies have been published concerning colonoscopic procedures. The U.S. Multi-Society Task Force advocates a cecal intubation rate of 95% for screening colonoscopy. Cecal intubation average times ranging from 4.5 to 7 minutes have been reported in large studies (2, 3). The accepted withdrawal time is 6 minutes for a thorough mucosal evaluation (4). The addition of polypectomy upon withdrawal adds an average of 4 minutes for a withdrawal time of 10 minutes (3).

Conclusion: By investigating the aforementioned quality measures, we have shown that fellowship trained colorectal surgeons are capable of high quality colonoscopy.