Volume and accreditation, but not specialty, affect quality standards in colonoscopy
Article first published online: 7 SEP 2012
Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
British Journal of Surgery
Volume 99, Issue 10, pages 1436–1444, October 2012
How to Cite
Bhangu, A., Bowley, D. M., Horner, R., Baranowski, E., Raman, S. and Karandikar, S. (2012), Volume and accreditation, but not specialty, affect quality standards in colonoscopy. Br J Surg, 99: 1436–1444. doi: 10.1002/bjs.8866
- Issue published online: 7 SEP 2012
- Article first published online: 7 SEP 2012
- Manuscript Accepted: 31 MAY 2012
The Global Rating Scale, defined by the Joint Advisory Group for Gastrointestinal Endoscopy, requires monitoring of endoscopic performance indicators. There are known variations in colonoscopic performance, and investigation of factors causing this is needed. This study aimed to analyse the impact of endoscopist specialty and procedural volume on the quality of colonoscopy.
Data collected prospectively from a UK hospital endoscopy service between June 2007 and January 2010 were analysed. The main endpoint was the adenoma detection rate (ADR). Secondary endpoints were polyp detection rate (PDR), reported caecal intubation rate (CIR) and reported complications. Multivariable binary regression models were built to adjust for confounding patient-level and endoscopist-level variation.
A total of 10 026 colonoscopies were included, with an overall ADR of 19·2 per cent, a CIR of 90·2 per cent and a perforation rate of 0·06 per cent. In univariable analyses, surgeons had a higher ADR and higher PDR, but lower CIR, compared with physicians. Surgeons had a significantly different case mix in terms of age, sex and indication for colonoscopy. After adjusting for this case mix in multivariable analysis, specialty was no longer a significant predictor of ADR; however, surgeons retained their higher PDR and physicians their higher CIR. Endoscopists accredited for screening and those performing more than 100 colonoscopies per year had a higher ADR.
Adjusting for case mix, physicians and surgeons performed equally well in terms of ADR. Accreditation and a higher annual number of colonoscopies were more important factors in achieving quality standards. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.