Colonoscopy Complication Rates Vary Among Hospitals

A new quality measure that uses follow-up hospital visits should be used track variations in colonoscopy quality among outpatient facilities, according to a new study.

Researchers at Yale University (New Haven, CT, USA) and Yale-New Haven Hospital (YNHH; CT, USA) reviewed a 20% sample of 2010 Medicare outpatient colonoscopy claims—331,880 colonoscopies performed at 8,140 facilities—from patients 65 years or older to develop a patient-level logistic regression model that can be used estimate the risk of an unplanned hospital visit (including emergency department visits, observational stays, and inpatient admissions) within seven days of undergoing a colonoscopy.

They then used the patient-level risk model variables and hierarchical logistic regression to estimate facility rates of risk-standardized unplanned hospital visits, this time using data from the Healthcare Cost and Utilization Project, which involved 325,811 colonoscopies at 992 facilities from four US states. The overall results showed that 1.63% of outpatient colonoscopies were followed by unplanned hospital visits within the week, with abdominal pain and perforation being the most common causes of the unplanned hospital visits.

In all, 15 variables were independently associated with unplanned hospital visits, with a history of fluid and electrolyte imbalance, psychiatric disorders, and (in the absence of prior arrhythmia), increasing age past 65 years being the most strongly associated. The researchers also found a wide variation in rates across facilities, ranging from 0.84% to over 2%. An extrapolation to the national population estimated that about 27,000 patients per year would have an unplanned hospital visit. The study was published in the January 2016 issue of Gastroenterology.

“This measure is a potentially useful tool for advancing patient-centered care. Publicly reporting facility quality will inform a patient's choice and make the full range of patient outcomes visible to providers, thereby addressing a critical information and quality measure gap,” concluded lead author Elizabeth Drye, MD, of the YNHH Center for Outcomes Research and Evaluation (CORE). “This measure can make transparent the extent to which patients require follow-up hospital care, help inform patient choices, and assist in quality-improvement efforts.”

Colonoscopy is the endoscopic examination of the colon and the distal part of the small bowel with a video or a fiber optic camera passed through the anus. It may provide a visual diagnosis (e.g., ulceration, polyps) and grants the opportunity for biopsy or removal of suspected lesions. Virtual colonoscopy, which uses imagery reconstructed from computed tomography (CT) scans or from nuclear magnetic resonance (MR) scans, is also possible, as a totally noninvasive medical test, although it is not standard and still under investigation regarding its diagnostic abilities.

Related Links:
Yale University
Yale-New Haven Hospital