Patient, Physician, and Procedure Characteristics Are Independently Predictive of Polyp Detection Rates in Clinical Prac
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ORIGINAL ARTICLE
Patient, Physician, and Procedure Characteristics Are Independently Predictive of Polyp Detection Rates in Clinical Practice Nicole G. Jawitz1 · Ziad F. Gellad1,2 · Li Lin3 · Richard K. Wood1 · David A. Leiman1,4 Received: 8 May 2020 / Accepted: 28 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Variability in colon polyp detection impacts patient outcomes. However, the relative influence of physician, patient, and procedure-specific factors on polyp detection is unclear. Therefore, determining how these factors contribute to adenoma and sessile serrated polyp (SSP) detection is important to contextualize measures of colonoscopy quality such as adenoma detection rate and patient outcomes. Aims To determine the relative contribution of physician, patient, and procedure-specific factors in total polyp, adenoma, and SSP detection rates. Methods We performed a retrospective study of patients undergoing screening colonoscopy and used a two-level generalized linear mixed regression model to identify factors associated with polyp detection. Results 7799 average risk screening colonoscopies were performed between July 2016 and October 2017. The patient factor most strongly associated with increased risk of adenoma and sessile serrated polyp detection was white race (OR 1.21, 95% CI 1.05–1.39 and OR 3.17, 95% CI 2.34–4.30, respectively). Adenomatous (OR 1.92, 95% CI 1.04–3.57) and sessile serrated polyps (OR 5.56, 95% CI 1.37–20.0) were more likely to be found during procedures performed with anesthesia care as compared to those with moderate sedation. Physician with a luminal gastrointestinal focus had increased odds of adenoma detection (OR 1.61, 95% CI 1.02–2.50). Conclusions In a multi-level model accounting for clustering effects, we identified patient, provider and procedural factors independently influence adenoma and sessile serrated polyp detection. Our findings suggest that to compare polyp detection rates between endoscopists, even at the same institution, risk adjustment by characteristics of the patient population and practice is necessary. Keywords Adenoma detection rate · Sessile serrated polyps · Screening colonoscopy · Colonoscopy quality Abbreviations ADR Adenoma detection rate BMI Body mass index MAC Monitored anesthesia care PDR Polyp detection rate SSPDR Sessile serrated polyp detection rate
* David A. Leiman [email protected] 1
Division of Gastroenterology, Duke University School of Medicine, 200 Morris Street, Suite 6524, Durham, NC 27701, USA
2
Durham VA Medical Center, Durham, NC, USA
3
Department of Population Health Sciences, Durham, NC, USA
4
Duke Clinical Research Institute, Durham, NC, USA
Introduction Adenoma detection rate (ADR) is a well-validated metric for evaluating screening colonoscopy quality [1, 2]. Higher ADR is correlated with a reduced risk of interval, advancedstage, and fatal colorectal cancer [3]. As a result, there is substantial interest in identifying factors that influen
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