Surveillance colonoscopies frequently booked earlier than the National Health and Medical Research Council guidelines: findings of a single centre audit

Abstract

Background: To assess the adherence rate of surveillance colonoscopy booking intervals to recommended National Health and Medical Research Council guidelines at The Queen Elizabeth Hospital, Adelaide, Australia.

Methods: Patients on The Queen Elizabeth Hospital colorectal unit surveillance colonoscopy waiting list were included in this audit. Patient demographics, colonoscopy findings, follow-up plans and pathology results were analysed. Patients were categorized as normal/non-neoplastic finding, low-risk adenomas, high-risk adenomas, personal history of colorectal cancer (CRC) and family history of CRC. Booked colonoscopy within 2 months of guideline recommended interval was considered correct.

Results: A total of 467 patients were included (59.1% male; mean age 60 years). Two hundred and fifty-one (53.7%) patients had an incorrect surveillance colonoscopy booking. Twenty-seven patients with a normal/non-neoplastic previous colonoscopy not requiring surveillance colonoscopy were incorrectly booked for a colonoscopy. For the 222 patients booked incorrectly and requiring surveillance colonoscopy, 88.7% were early and 11.3% were late. The proportions of incorrect bookings were highest in the low-risk finding (66.1%) and history of CRC (67.6%) groups. For the 186 patients requiring a 3-year surveillance interval, 38.7% were booked incorrectly. For the 197 patients requiring a 5-year surveillance interval, 63.5% were booked incorrectly, of which 99.2% were early. More 5-year surveillance interval patients were booked at 3 years (n = 79), than at the correct interval of 5 years (n = 72).

Conclusion: Adherence to the National Health and Medical Research Council guidelines for surveillance colonoscopy is poor. The majority of deviations represent early follow-up, which is most common among patients with low-risk findings or history of CRC. There is a tendency towards 3-year surveillance among low-risk patients.

Keywords: colonoscopy; colorectal neoplasm; guideline adherence; medical audit; surveillance.