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Endoscopist fatigue does not affect adenoma detection rate for colonoscopy
Researchers found no associations between adenoma detection rate for colonoscopy and several measures of endoscopist fatigue in a study of community-based practices.
“In a large community-based integrated health care delivery setting, we found that colonoscopies performed in the afternoon were not less likely to detect adenomas than examinations in the morning and that endoscopist fatigue based on the number of prior GI procedures performed, with or without consideration of procedure complexity, was not inversely associated with colonoscopic adenoma detection within the range of procedure volumes evaluated,” Douglas A. Corley, MD, PhD, of the division of research at Kaiser Permanente Northern California (KPNC), and colleagues wrote.
Douglas A. Corley
In a retrospective cross-sectional study, Corley and colleagues identified 126 KPNC gastroenterologists who performed a total of 259,064 GI procedures, a median of six per day, and a range of one to 24 per day, between 2010 and 2013. Among these procedures, 76,445 were screening or surveillance colonoscopies, and the investigators assessed for associations between the adenoma detection rates (ADRs) for these procedures and four measures of endoscopist fatigue.
These fatigue measures included the time of day the colonoscopy was performed, and three different scores based on the number of GI procedures the endoscopist performed before the colonoscopy on the same day, two of which accounted for the complexity of the prior procedures.
Mean physician ADRs were 28.9% for screening colonoscopies (34.8% for men and 24% for women) and 45.4% for surveillance colonoscopies (51.1% for men and 37.8% for women), which were consistent with quality benchmarks.
The investigators found that both morning and afternoon screening and surveillance colonoscopies resulted in comparable ADRs (OR = 0.99; 95% CI, 0.96-1.03), and that highest vs. lowest quartiles of prior procedures performed that day, regardless of their complexity, resulted in comparable ADRs (OR = 0.99; 95% CI, 0.94-1.04).
However, there was an “unexpected” but small relative increase (8% to 12%) in ADR for screening colonoscopies after the first screening colonoscopy of the day, and then a return to baseline for subsequent screening colonoscopies, Corley and colleagues noted.
“This is the first study, to our knowledge, to report this possible ‘warming up’ effect,” they wrote. “With its repetitive nature and reliance on stereotypical and rehearsed movements, colonoscopy may be an activity in which peak performance is reached after one or a few initial endoscopy procedures are completed and the operator’s movements are comfortably set,” but the clinical relevance of this is unclear, they concluded. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.