Endoscopist fatigue estimates and colonoscopic adenoma detection in a large community-based setting

Abstract

Background and aims: Endoscopist fatigue may impact colonoscopy quality, but prior studies conflict, and minimal data exist from community-based practices where most colonoscopies are performed.

Methods: Within a large, community-based integrated healthcare system, we evaluated the associations among 4 measures of endoscopist fatigue and colonoscopic adenoma detection from 2010 to 2013. Fatigue measures included afternoon versus morning colonoscopy and the number of GI procedures performed before a given colonoscopy, including consideration of prior procedure complexity. Analyses were adjusted for potential confounders using multivariate logistic regression.

Results: We identified 126 gastroenterologists who performed 259,064 total GI procedures (median, 6 per day; range, 1-24), including 76,445 screening and surveillance colonoscopies. Compared with morning examinations, colonoscopies in the afternoon were not associated with lower adenoma detection for screening examinations, surveillance examinations, or their combination (OR for combination, .99; 95% CI, .96-1.03). The number of procedures performed before a given colonoscopy, with or without consideration of prior procedure complexity, was also not inversely associated with adenoma detection (OR for adenoma detection for colonoscopies in the fourth quartile of fatigue based on the number of prior procedures performed vs colonoscopies performed as the first procedure of the day, .99; 95% CI, .94-1.04).

Conclusions: In a large community-based setting, adenoma detection for screening and surveillance colonoscopies were not associated with either time of day or the number of prior procedures performed by the endoscopist, within the range of procedure volumes evaluated. The lack of association persisted after accounting for prior procedure complexity.

Figure 1. The frequency of colonoscopic adenoma detection by endoscopist fatigue score

Raw fatigue score is the sum of the raw weights for the GI procedures performed by the physician before the given colonoscopy; consensus fatigue score is the sum of the consensus weights for the GI procedures performed by the physician before the given colonoscopy; and RVU fatigue score is the sum of the RVU weights for the GI procedures performed by the physician before the given colonoscopy.

Figure 2. Association between endoscopist fatigue scores (raw, consensus, and RVU fatigue scores) and colonoscopic adenoma detection (screening and surveillance colonoscopy examinations)

1^st of Day is the reference and refers to the colonoscopies that were the first GI procedures of the day. Error bars represent 95% confidence intervals. RVU, relative value units. Raw fatigue score is the sum of the raw weights for the GI procedures performed by the physician before the given colonoscopy; consensus fatigue score is the sum of the consensus weights for the GI procedures performed by the physician before the given colonoscopy; and RVU fatigue score is the sum of the RVU weights for the GI procedures performed by the physician before the given colonoscopy.