Bradley W Evans, MD, David Pace, MD, Mark Borgaonkar, MD, Matthew Miné-Goldring, Melissa Meng, Jane Brodie, Darryl Boone, Jerry Mcgrath. Memorial University of Newfoundland
Introduction: We aimed to assess the effect of a colonoscopy skills improvement (CSI) course on quality indicators for surgeons at our institution.
Methods: This retrospective cohort study was performed on nine surgeons practicing in a tertiary referral center who had undergone CSI training between October 2014 and December 2015. Procedural data for 50 colonoscopies were collected immediately before and after CSI training, and again 8 months after training. The primary outcome variable was adenoma detection rate (ADR) and secondary outcomes included colonoscopy completion rate (CCR), withdrawal time (WT), sedation usage, and the amount of sedation used. Data were extracted from the electronic medical record (EMR) and entered into SPSS version 20.0 for analysis. Univariate analysis followed by stepwise multivariable logistic regression was performed to determine whether there was an association between quality outcomes and predictors of these outcomes including patient age, gender, indication for colonoscopy, quality of bowel preparation, and CSI training.
Results: 1350 colonoscopies were studied (450 at each time point). ADR improved non-significantly after completing the course (30.9% v. 31.6%, p<0.886) and increased further to significance at 8 months (30.9% v. 37.6%, p=0.042). There was a significant decrease in mean dosage per procedure for both fentanyl (80.7mcg v. 70.1mcg v. 67.1mcg, p<0.001) and versed (2.62mg v. 2.16mg v. 2.11mg, p<0.001) after CSI training. There was no change in CCR, WT, or sedation usage.
Using multivariate analysis, increased patient age, male gender, and the 8-month time point following CSI training were associated with increased ADR when controlling for prep adequacy and procedure indication. Lower mean doses of fentanyl and versed were associated with CSI training when we accounted for patient age, patient gender, prep adequacy, procedure completion and procedure indication.
Conclusion: CSI training is associated with an improvement in ADR and a decrease in the amount of sedation used by surgeons at our institution.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92008
Program Number: S147
Presentation Session: Flexible Endoscopy II
Presentation Type: Podium