Colonoscopy completion and complication rates in a community gastroenterology practice

Abstract

Background: In the United States, colonoscopy completion and complication rates are rarely reported outside academic institutions. Increased transparency of quality measures and outcomes is being driven by professional societies, government agencies, and private enterprise.

Objective: To collect and report the completion and complication rates of colonoscopy in a community gastroenterology practice.

Design: Single-center study, prospective for completion, retrospective for complications.

Setting: Community gastroenterology group practice, conducted from August 2002 through December 2004.

Patients: A total of 12,407 consecutive patients referred for colonoscopy; mean age, 59.7 years; 5925 men.

Interventions: Polypectomy and cautery were completed as indicated.

Main outcome measures: Completion of colonoscopy to cecum or ileocolonic anastomosis. Complications of hemorrhage and perforation.

Results: A colonoscopy was completed in 98.4% of patients. Polypectomy was accomplished in 5074 (40.9%). Polyps occurred more often in men (46.4% vs 35.8%, P < .001). Causes for failure included difficult anatomy (55.9%), inadequate preparation (20.8%), obstructing malignancy (8.6%), discomfort (8.1%), and severe inflammation (6.1%). Failure from difficult anatomy was more likely in women (1.19% vs 0.56%, P < .001). Hemorrhage requiring hospitalization occurred after 25 cases (0.20%). Twenty-three episodes of bleeding occurred after polypectomy (0.46%) and 2 after treatment of arteriovenous malformations. Two perforations occurred (0.016%). One patient developed a posterior circulation stroke. No deaths occurred.

Limitations: Completion not independently verifiable. Complications were collected retrospectively.

Conclusions: Colonoscopy completion and complication rates in this community gastroenterology practice compared favorably with U.S. academic centers. Endoscopic quality in community practices can meet published outcomes.