Introduction: Colonoscopies can have suboptimal outcomes due to poor quality bowel preparation leading to missed identification of polyps, exposure to unnecessary anesthesia, and decreased patient and clinician satisfaction. We aimed to understand predictors of suboptimal bowel preparation and assess the utility of a color-based stool self-assessment tool in a single ambulatory surgical center (ASC).
Methods: In our prospective study, we administered a survey to patients prior to scheduled colonoscopies. Patients rated the color of their stool on a scale from one (yellow and clear) to five (dark and murky) using a visual card. Need for pre-operative or intra-operative cancellation was noted. Boston bowel preparation scale (BPPS) was scored by the endoscopist during colonoscopy. Statistical analysis was performed using Stata.
Results: 1,511 patients who underwent colonoscopies at the ASC between August and December 2022 were included in the study. BPPS mean was 7.2 (SD 1.5) and color-based stool score mean was 1.2 (SD 0.6). Cancellation/aborted procedure occurred in 92 cases (6.1%). Based on receiver operating characteristic curve, BPPS and color-based stool score both predicted cancellations, but BPPS outperformed the color-based tool (Figure 1).
We found that patient characteristics associated with procedure cancellation included age, race, history of constipation, incomplete bowel preparation, and a higher score on the color-based self-assessment stool scale (Table 1). The aforementioned clinical variables, excluding a history of constipation and incomplete bowel preparation, were statistically significant with respect to BPPS < 6. In multivariate analysis, factors associated with cancellation included age (OR = 1.026, 95% CI 1.005-1.047), history of constipation (OR = 1.949, 95% CI 1.181 – 3.218), and a higher score on the color-based self-assessment stool scale (OR = 2.741, 95% CI 2.129 - 3.529). Miralax and Dulcolax bowel preparation had a negative association with cancellation (OR = 0.407, 95% CI 0.171 - 0.966).
Discussion: Our results identify several variables which contribute to suboptimal bowel preparation and pre-operative/intra-operative cancellation in the ambulatory setting, and these clinical factors provide potential targets for intervention. The color-based stool self-assessment tool can serve as an indicator for need for same-day procedure cancellation.
Figure: Figure 1: ROC curves of Stool Color Score vs BPPS for predicting colonoscopy pre-operative cancellation or intra-operative procedure abortion. Stool color score AUC 0.6225 compared to BPPS AUC 0.8553. Optimal cutoffs via Liu criterion and Youden Index are as follows: Stool Color Score 1.5 and BPPS 5.5.
Abbreviations: Receiver Operating Characteristic (ROC), Boston Bowel Preparation Scale (BPPS), Area Under the Curve (AUC)
Disclosures:
Nicole Paul indicated no relevant financial relationships.
Ria Bansal indicated no relevant financial relationships.
Cassandra Taraska indicated no relevant financial relationships.
Tammy Hunt indicated no relevant financial relationships.
Joan Rodgers indicated no relevant financial relationships.
Nikki Warner indicated no relevant financial relationships.
Yisi Liu indicated no relevant financial relationships.
Dhananjay Vaidya indicated no relevant financial relationships.
Shanshan Huang indicated no relevant financial relationships.
Ekta Gupta indicated no relevant financial relationships.
Nicole Paul, MD1, Ria Bansal, 2, Cassandra Taraska, BSN3, Tammy Hunt, BSN3, Joan Rodgers, BSN3, Nikki Warner, BSN3, Yisi Liu, MHS1, Dhananjay Vaidya, PhD, MBBS, MPH1, Shanshan Huang, MBA1, Ekta Gupta, MBBS1. P1765 - Prep for Success: Contributors to Suboptimal Colonoscopy Bowel Preparation in an Ambulatory Surgical Center, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
