Patient, Physician, and Procedure Characteristics Are Independently Predictive of Polyp Detection Rates in Clinical Practice

Sep 7, 2020Digestive diseases and sciences

Patient, Doctor, and Procedure Factors Each Predict Polyp Detection Rates in Medical Exams

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Abstract

A total of 7,799 screening colonoscopies were performed, revealing that white race is associated with an increased risk of adenoma and sessile serrated polyp detection.

White race is associated with a higher likelihood of adenoma detection (odds ratio 1.21) and sessile serrated polyp detection (odds ratio 3.17).
Procedures performed with anesthesia care are linked to increased detection rates of adenomatous (odds ratio 1.92) and sessile serrated polyps (odds ratio 5.56) compared to those with moderate sedation.
Physicians with a luminal gastrointestinal focus have higher odds of detecting adenomas (odds ratio 1.61).
Patient, provider, and procedural factors independently influence polyp detection rates.

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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.

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Patient, Physician, and Procedure Characteristics Are Independently Predictive of Polyp Detection Rates in Clinical Practice

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