P0342 - Effectiveness of Weekend Colonoscopy to Address Procedural Backlog in the County Setting

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

CM

Christo Mathew, MD

Baylor College of Medicine
Houston, TX

Christo Mathew, MD, Disha Kumar, MD, Jane Montealegre, PhD, Milena Gould, MD
Baylor College of Medicine, Houston, TX

Introduction: At our county hospital system in Houston, Texas, there is a backlog of colonoscopies due to many factors including delays during the COVID pandemic and patient availability during normal working hours. To improve colonoscopy completion rates and thus colorectal cancer (CRC) screening, weekend colonoscopies became available at our institution to address the backlog of scheduled cases. We evaluated the quality of these weekend colonoscopies to ensure the effectiveness of CRC screening efforts.

Methods: We retrospectively analyzed demographic, logistical, and procedural data for outpatient colonoscopies completed in two weeks in November and December 2021 that each led up to weekend procedure days. We compared the outcomes of outpatient colonoscopies completed on weekend days compared to those completed on weekdays. Outcomes included variations in Boston Bowel Preparation Scale (BBPS), adenoma detection rate (ADR), and cecal intubation rate (CIR), as well as the time between positive fecal immunochemical test (FIT) and colonoscopy. Fisher’s exact and Mann-Whitney tests were used to compare categorical variables. Student’s t-test was used to compare means.

Results: 95 colonoscopies were scheduled during our study period, of which 19 were scheduled on a weekend day. Weekend days had a significantly larger proportion of cases for diagnostic colonoscopy for positive FIT (p-value 0.01). The average time between positive FIT and the date of colonoscopy was close to 1 year for both weekdays and weekend days. The cancellation rate on weekends trended lower compared to weekdays (p-value 0.11). There was no difference in BBPS score between weekdays and weekend days (p-value 0.53). ADR trended higher on weekend days (p-value 0.26). CIR was > 95% on both weekday and weekend procedure days.

Discussion: We found that weekend days had a greater proportion of cases performed for positive FIT. The quality of colonoscopies on the weekend was similar to that on weekdays, with no difference found in BBPS, ADR, or CIR. However, the cancellation rate on weekends was lower. We speculate that patients in our underserved health system may have more availability to prep for and attend weekend colonoscopies compared to weekdays. Adding more weekend colonoscopy days may lead to higher rates of completed colonoscopies for positive FIT and thus improve early diagnosis of CRC.

		Weekdays (N = 76)		Saturdays (N = 19)		p-value
		n	%	n	%
Gender	Female	40	52.6	13	68.4	0.30
	Male	36	47.4	6	31.6	0.30

Ethnicity	Hispanic	34	44.7	9	47.4	1.00

Race	White/Caucasian	27	35.5	6	31.6	0.97
	African American	23	30.3	7	36.8
	Asian	2	2.6	0	0.0
	Other	24	31.6	6	31.6

Insurance Coverage		41	53.9	13	68.4	0.31

Primary Language	English	42	55.3	11	57.9	1.00
	Spanish	28	36.8	8	42.1	1.00

No show and/or cancelled		17	22.4	1	5.3	0.11

ASA*	2	14	23.7	6	33.3	0.54
	3	45	76.3	12	66.7	0.54

BBPS*	≤5	1	1.7	0	0.0	0.53
	6	12	20.3	0	0.0
	7	5	8.5	0	0.0
	8	3	5.1	7	38.9
	9	38	64.4	11	61.1

Adenoma(s) detected		23	39.0	10	55.6	0.28
Cecal intubation rate		57	96.6	18	100.0

Diagnostic for positive FIT		11	14.5	9	47.4	0.01

Average number of days between positive FIT and colon		312		405		0.40

N = colonoscopies performed (59 for weekday, 18 for Saturdays)
ASA = American Society of Anesthesiologists (ASA) physical status classification system was developed
FIT = fecal immunohistochemical test
BBPS = Boston Bowel Preparation Scale

Table: Table 1: Weekend colonoscopy patient, procedure, and procedural quality characteristics

Disclosures:

Christo Mathew indicated no relevant financial relationships.

Disha Kumar indicated no relevant financial relationships.

Jane Montealegre indicated no relevant financial relationships.

Milena Gould indicated no relevant financial relationships.

Christo Mathew, MD, Disha Kumar, MD, Jane Montealegre, PhD, Milena Gould, MD. P0342 - Effectiveness of Weekend Colonoscopy to Address Procedural Backlog in the County Setting, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.