Lieke Hol1, Rinku Sutradhar2, Sumei Gu2, Nancy N Baxter3, Linda Rabeneck4, Jill M Tinmouth5, Lawrence F Paszat5. 1. Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, the Netherlands. 2. Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. 3. Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Department of Surgery and Li Ka Shing Research Institute, St. Michael's Hospital, Toronto, Ont. 4. Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ont. 5. Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Sunnybrook Health Sciences Centre, Toronto, Ont.
Abstract
BACKGROUND: Data suggest the overuse of repeat colonoscopies, especially in patients at low risk for colorectal cancer. Our objective was to evaluate the time to repeat colonoscopies in low-risk patients aged 50-79 years old and the associated patient- and endoscopist-related factors. METHODS: All patients aged 50-79 years of age who underwent a complete outpatient colonoscopy with a negative result between 2000 and 2007 were identified from the Ontario Health Insurance Plan database. A colonoscopy performed within 5.5 years of follow-up after the index colonoscopy was considered an early repeat colonoscopy. Patient, endoscopist and endoscopy setting characteristics were recorded and their association with an early repeat colonoscopy was determined using an extended Cox proportional hazards regression model. RESULTS: The cohort consisted of 546 467 patients: 55.4% of the patients were female with a mean age of 61.1 years (95% confidence interval [CI] 61.1-61.2). The cumulative percentage of early repeat colonoscopy after 5.5 years was 33.7%. The rate decreased significantly between 2000 and 2007 (hazard ratio [HR] 0.35, 95% CI 0.34-0.36). General surgeons were associated with a higher risk of early repeat colonoscopy than gastroenterologists (HR 1.27, 95% CI 1.25-1.28). Endoscopists practising in a nonhospital setting were more likely to perform an early repeat colonoscopy (HR 1.26, 95% CI 1.22-1.30) than endoscopists at a hospital. INTERPRETATION: This study showed that there was overuse of early repeat colonoscopy in more than 30% of patients who were at low risk for colorectal cancer. The risk decreased significantly between 2000 and 2007 but was still greater than 20% in 2007. Our findings can be used to develop targeted educational interventions among subgroups of endoscopists with a higher rate of early repeat colonoscopy.
BACKGROUND: Data suggest the overuse of repeat colonoscopies, especially in patients at low risk for colorectal cancer. Our objective was to evaluate the time to repeat colonoscopies in low-risk patients aged 50-79 years old and the associated patient- and endoscopist-related factors. METHODS: All patients aged 50-79 years of age who underwent a complete outpatient colonoscopy with a negative result between 2000 and 2007 were identified from the Ontario Health Insurance Plan database. A colonoscopy performed within 5.5 years of follow-up after the index colonoscopy was considered an early repeat colonoscopy. Patient, endoscopist and endoscopy setting characteristics were recorded and their association with an early repeat colonoscopy was determined using an extended Cox proportional hazards regression model. RESULTS: The cohort consisted of 546 467 patients: 55.4% of the patients were female with a mean age of 61.1 years (95% confidence interval [CI] 61.1-61.2). The cumulative percentage of early repeat colonoscopy after 5.5 years was 33.7%. The rate decreased significantly between 2000 and 2007 (hazard ratio [HR] 0.35, 95% CI 0.34-0.36). General surgeons were associated with a higher risk of early repeat colonoscopy than gastroenterologists (HR 1.27, 95% CI 1.25-1.28). Endoscopists practising in a nonhospital setting were more likely to perform an early repeat colonoscopy (HR 1.26, 95% CI 1.22-1.30) than endoscopists at a hospital. INTERPRETATION: This study showed that there was overuse of early repeat colonoscopy in more than 30% of patients who were at low risk for colorectal cancer. The risk decreased significantly between 2000 and 2007 but was still greater than 20% in 2007. Our findings can be used to develop targeted educational interventions among subgroups of endoscopists with a higher rate of early repeat colonoscopy.
Authors: David A Lieberman; Douglas K Rex; Sidney J Winawer; Francis M Giardiello; David A Johnson; Theodore R Levin Journal: Gastroenterology Date: 2012-07-03 Impact factor: 22.682
Authors: J Sint Nicolaas; V de Jonge; O van Baalen; F J G M Kubben; W Moolenaar; M F J Stolk; E J Kuipers; M E van Leerdam Journal: Endoscopy Date: 2013-04-11 Impact factor: 10.093
Authors: Vikram Boolchand; Gregory Olds; Joseph Singh; Pankaj Singh; Amitabh Chak; Gregory S Cooper Journal: Ann Intern Med Date: 2006-11-07 Impact factor: 25.391
Authors: F Balaguer; J Llach; A Castells; J M Bordas; M Ppellisé; F Rodríguez-Moranta; A Mata; G Fernández-Esparrach; A Ginès; J M Piqué Journal: Aliment Pharmacol Ther Date: 2005-03-01 Impact factor: 8.171
Authors: Kristin M Sheffield; Yimei Han; Yong-Fang Kuo; Taylor S Riall; James S Goodwin Journal: JAMA Intern Med Date: 2013-04-08 Impact factor: 21.873
Authors: Robert E Schoen; Paul F Pinsky; Joel L Weissfeld; Lance A Yokochi; Douglas J Reding; Richard B Hayes; Timothy Church; Susan Yurgalevich; V Paul Doria-Rose; Tom Hickey; Thomas Riley; Christine D Berg Journal: Gastroenterology Date: 2009-10-08 Impact factor: 22.682
Authors: Shane Hadlock; Linda Rabeneck; Lawrence F Paszat; Rinku Sutradhar; Andrew S Wilton; Jill Tinmouth Journal: Can J Gastroenterol Date: 2013-06 Impact factor: 3.522
Authors: Jae Myung Cha; Min Seob Kwak; Hyun-Soo Kim; Su Young Kim; Sohee Park; Geun U Park; Jung Kuk Lee; Soo Jin Kim; Hun Hee Lee; Joo Sung Kim; Won Ho Kim Journal: Gut Liver Date: 2020-05-15 Impact factor: 4.519
Authors: Lawrence F Paszat; Rinku Sutradhar; Elyse Corn; Jill Tinmouth; Nancy N Baxter; Linda Rabeneck Journal: J Can Assoc Gastroenterol Date: 2020-10-15