ADR decreases when colonoscopies delayed more than 1 hour

SAN DIEGO — When colonoscopy delays of an hour or more occur, adenoma detection rates decrease significantly and delays of more than 2 hours impact quality of bowel preparation, according a presenter at DDW 2016.

“Long delays appear to cause a reduction in colonoscopy quality and efforts should be made to minimize delays for screening colonoscopies,” Monika Laszkowska, MD, from the division of digestive and liver diseases, department of medicine, New York Presbyterian Hospital/Columbia University Medical Center, New York City, said during her presentation.

Monika Laszkowska

Laszkowska and colleagues looked at electronic endoscopy records from Jan. 1, 2011, through June 30, 2015. Once excluding procedures with two attendings, those that were repeat colonoscopies and those without a scheduled start time, the study included 8,546 colonoscopies for which data collection included scheduled case time, actual start time, ADR and preparation quality.

The mean delay time was 53 minutes and 898 (11%) started on time while 2,669 (31%) were delayed by more than 1 hour.

Laszkowska showed that ADR for cases starting within the hour of their scheduled time was 24%. Those delayed between 1 and 2 hours and those delayed more than 2 hours saw a decreased ADR to 21% (P = .01).

“As the delay time increased above 1 hour, there was a significant decrease in ADR,” Laszkowska said.

Further breakdown by time of colonoscopy showed that afternoon procedures did not have a significant change in ADR with delays. Morning colonoscopy ADR, however, decreased from 24% if starting on time to 21% at a 1- to 2-hour delay and 19% when delayed more than 2 hours (P = .018).

Additionally, Laszkowska showed that the percentage of patients with suboptimal bowel prep increased with increasing delays. If the procedure began within an hour of scheduled time, 19% of patients had suboptimal bowel preparation. Between 1 and 2 hours delayed, 20% were suboptimal and when delayed more than 2 hours, 25% of patients had suboptimal bowel preparation (P = .01).

This difference was again more pronounced in morning procedures, she showed. Overall, more afternoon patients had suboptimal preparation (18% vs. 24%; P < .01), but afternoon patients did not worsen with delays. Of the morning cases that started within an hour of schedule, 18% were suboptimal, a rate that increased to 26% if delayed more than 2 hours (P = .001).

“Delays of more than 2 hours impact preparation quality, particularly in morning cases,” she said.

Reference:

Laszkowska M, et al. Abstract #254. Presented at: Digestive Disease Week. May 21-24, 2016; San Diego.

Disclosures: Laszkowska reports no relevant financial disclosures.

Editor's Note: This item was updated with clarifications from the presenter.