Curtis Marcoux, BSc, David Pace, MD, Mark Borgaonkar, MD, MSc, Lougheed Muna, BSc, Brad Evans, BSc, Darrell Boone, MD, Jerry McGrath, MD, MSc. Memorial University of Newfoundland
Introduction: The growing importance of colonoscopy for the prevention and early detection of colorectal cancer has led to increasing emphasis on the quality of endoscopic procedures. Patient comfort is considered a performance indicator for colonoscopy. Our aim was to assess predictors of patient comfort during colonoscopy.
Methods: A retrospective cohort study was performed on 3235 patients who underwent colonoscopy in St. John’s, NL in the year 2012. Data from 628 patients were excluded due to the absence of patient comfort score. Data were obtained from endoscopic procedure reports and nursing reports in the electronic medical record (EMR). The relationship between patient comfort and the following variables was evaluated: patient age, patient gender, ASA classification, use of sedation, incomplete endoscopy, endoscopist performing the procedure, specialty of the endoscopist, and annual volume, quality of bowel preparation, and type of bowel preparation. Univariate analysis using ANOVA for continuous variables and Chi-squared test for categorical variables was performed to identify variables associated with patient comfort (p ≤ 0.1). Multivariate logistic regression was performed to identify variables independently associated with patient comfort (p ≤ 0.05). Data on patient comfort were obtained by reviewing the endoscopy nursing notes recorded during the procedure and patients were classified as confortable or uncomfortable. For comparisons using colonoscopy volume, endoscopists were divided into two groups based on annual volume: those who performed at least 250 colonoscopies (high volume) and those who performed fewer (low volume).
Results: Mean patient age was 58.4 (±12.4) with 55.8% being female. Data from colonoscopies performed by 8 gastroenterologists and 13 general surgeons were obtained. Gastroenterologists performed 2048 (63.3%) colonoscopies while general surgeons performed 1187 (36.7%). 29% of patients were noted to have discomfort. In univariate analysis, mean age was lower in patients who reported discomfort (56.5 vs. 59.0; p < 0.001). Discomfort was noted more frequently in women compared to men (36.1% vs. 19.9% p < 0.001), in patients with higher mean ASA classification (2.57 vs. 2.44, p = 0.048), and incomplete colonoscopy (66.7% vs. 26.3%; p < 0.001). Moreover, discomfort was associated with the endoscopist performing the procedure (range: 18.2% to 65.6%; p < 0.001), general surgeons compared to gastroenterologists (31.1% vs. 27.3%; p = 0.009), and endoscopists performing fewer than 250 annual colonoscopies (37.2% vs. 27.3%; p ≤ 0.001). Multivariate analysis demonstrated that female patients (OR = 2.179, p < 0.001) and younger patients (OR = 1.02, p < 0.001) were more likely to report discomfort during colonoscopy. Furthermore, incomplete endoscopy (OR = 5.387, p < 0.001) and low annual endoscopy volume (OR = 1.610; p < 0.001) were independently associated with patient discomfort. In the multivariate analysis, the endoscopist performing the procedure, specialty of the endoscopist, and ASA classification did not maintain significance.
Conclusion: Female gender, younger age, incomplete colonoscopy and low annual endoscopy volume are associated with higher levels of discomfort.