Colonoscopy utilization and outcomes 2000 to 2011 Lieberman, David A., MD; Williams, J. Lucas, MPH; Holub, Jennifer L., MPH ...
Gastrointestinal endoscopy,
07/2014, Letnik:
80, Številka:
1
Journal Article
Recenzirano
Background Understanding colonoscopy utilization and outcomes can help determine when the procedure is most effective. Objective To study trends in utilization and outcomes of colonoscopy in the ...United States from 2000 to 2011. Design Prospective collection of colonoscopy data. Setting A total of 84 adult diverse GI practices. Patients All adult patients receiving colonoscopy for any reason. Intervention Colonoscopy. Main Outcome Measurements Polyps >9 mm or suspected malignant tumor. Results We analyzed 1,372,838 reports. The most common reason for colonoscopy in patients aged <50 years is evaluation of symptoms such as irritable bowel syndrome (IBS) (28.7%) and bleeding or anemia (35.3%). In patients aged 50 to 74 years, colorectal cancer screening accounts for 42.9% of examinations. In patients aged >74 years, surveillance for cancer or polyps is the most common indication. The use of colonoscopy for average-risk screening increased nearly 3-fold during the study period. The prevalence of large polyps increases with age and is higher in men for every procedure indication. The prevalence of large polyps in patients with symptoms of IBS was lower than in those undergoing average-risk screening (odds ratio OR 0.85; 95% confidence interval CI, 0.83-0.87). With increasing age, there was a shift from distal to proximal large polyps. The rate of proximal large polyps is higher in the black population compared with the white population (OR 1.19; 95% CI, 1.13-1.25). Limitations In the absence of pathology data, use of surrogate as the main outcome. Conclusion Colonoscopy utilization changed from 2000 to 2011, with an increase in primary screening. The proximal location of large polyps in the black population and with advancing age has implications for screening and surveillance.
Background The adenoma detection rate (ADR) is one of the main quality measures for colonoscopy, but it is burdensome to calculate and is not amenable to claims-based reporting. Objective To validate ...the correlation between polypectomy rates (PRs) and ADRs by using a large group of endoscopists. Design Retrospective study. Setting Community and academic endoscopy units in the United States. Subjects Sixty endoscopists and their patients. Main outcome measurements Proportion of patients with any adenoma and any polyp removed; correlation between ADRs and PRs. Results In total, 14,341 screening colonoscopies were included, and there was high correlation between endoscopists' PRs and ADRs in men ( rs = .91, P < .0001) and women (rs = .91, P < .0001). Endoscopists with PRs in the highest quartile had a significantly higher ADR than did those in the lowest quartile in men (44.6% vs 19.4%, P < .0001) and women (33.6% vs 11.6%, P < .0001). Endoscopists in the top polypectomy quartile also found more advanced adenomas than did endoscopists in the bottom quartile (men: 9.6% vs 4.6%, P = .0006; women: 6.3% vs 3.0%, P = .01). Benchmark PRs of 40% and 30% correlated with ADRs greater than 25% and 15% for men and women, respectively. Limitation Retrospective analysis of a subset of a national endoscopic database. Conclusions Endoscopists' PRs correlate well with their ADRs. Given its clinical relevance, its simplicity, and the ease with which it can be incorporated into claims-based reporting programs, the PR may become an important quality measure.
Background and Aims Currently, there are no quality measures specific to children undergoing GI endoscopy. We aimed to determine the baseline quality of pediatric colonoscopy by using the Pediatric ...Endoscopy Database System—Clinical Outcomes Research Initiative (PEDS-CORI), a central registry. Methods We conducted prospective data collection by using a standard computerized report generator and central registry (PEDS-CORI) to examine key quality indicators from 14 pediatric centers between January 2000 and December 2011. Specific quality indicators, including bowel preparation, ileal intubation rate, documentation of American Society of Anesthesiologists Physical Status Classification System (ASA) class, and procedure time, were compared during the study period. Results We analyzed 21,807 colonoscopy procedures performed in patients with a mean age of 11.5 ± 4.8 years. Of the 21,807 reports received during the study period, 56% did not include bowel preparation quality, and 12.7% did not include ASA classification. When bowel preparation was reported, the quality was described as excellent, good, or fair in 90.3%. The overall ileal intubation rate was 69.4%, and 15.6% reported cecal intubation only, calculated to be 85% cecum or ileum intubation. Thus, 15% of colonoscopy procedures did not report reaching the cecum or ileum. When excluding the proportion of procedures not intended to reach the ileum (31.5%), the overall ileal intubation rate increased to 84.0%. The rate of ileum examination varied from 85% to 95%, depending on procedure indication. Conclusions Colonoscopy reports from our central registry revealed significant variations and inconsistent documentation in pediatric colonoscopy. Our study identifies areas for quality improvement and highlights the need for developing accepted quality measures specific to pediatric endoscopy.
Background Data on the use of endoscopic hemostasis performed during colonoscopy for hematochezia are primarily derived from expert opinion and case series from tertiary care settings. Objectives To ...characterize patients with hematochezia who underwent in-patient colonoscopy and compare those who did and did not receive endoscopic hemostasis. Design Retrospective analysis. Setting Clinical Outcomes Research Initiative National Endoscopic Database, 2002 to 2008. Patients Adults with hematochezia. Interventions None. Main Outcome Measurements Demographics, comorbidities, practice setting, adverse events, and colonoscopy procedural characteristics and findings. Results We identified 3151 persons who underwent in-patient colonoscopy for hematochezia. Endoscopic hemostasis was performed in 144 patients (4.6%). Of those who received endoscopic hemostasis, the majority were male (60.3%), white (83.3%), and older (mean age 70.9 ± 12.3 years); had a low-risk American Society of Anesthesiologists classification (53.9%); and underwent colonoscopy in a community setting (67.4%). The hemostasis-receiving cohort was significantly more likely to be white (83.3% vs 71.0%, P = .02), have more comorbidities (classes 3 and 4, 46.2% vs 36.0%, P = .04), and have the cecum reached (95.8% vs 87.7%, P = .003). Those receiving hemostasis were significantly more likely to have an endoscopic diagnosis of arteriovenous malformations (32.6% vs 2.6%, P = .0001) or a solitary ulcer (8.3% vs 2.1%, P < .0001). Limitations Retrospective database analysis. Conclusions Less than 5% of persons presenting with hematochezia and undergoing inpatient colonoscopy received endoscopic hemostasis. These findings differ from published tertiary care setting data. These data provide new insights into in-patient colonoscopy performed primarily in a community practice setting for patients with hematochezia.
Background The adenoma detection rate (ADR) has recently been used as a quality measure for screening colonoscopy. We hypothesize that the ADR will increase with each decade of life after 50 years of ...age. Objective The aim of this study was to define age-based goals for the ADR and advanced neoplasia to improve the quality of colonoscopy. Methods Using the Clinical Outcomes Research Initiative database, we identified patients who underwent screening colonoscopy between 2005 and 2006. Pathology of polyp findings was reviewed, and the ADR and the prevalence of advanced neoplasia were calculated based on age and sex. Results A total of 7756 polypectomies (44.9%) were performed on 17,275 patients between 2005 and 2006. Of these polyps, 56.3% (4363) were adenomas or more advanced lesions. The ADR was higher in men than women and increased with age. The ADR in men younger than age 50 was 24.7 (95% CI, 18.2-31.2); for those 50 to 59 years of age, it was 27.8 (95% CI, 26.5-29.1); for those 60 to 69 years of age, it was 33.6 (95% CI, 31.7-35.4); for those 70 to 79 years of age, it was 34.3 (95% CI, 31.5-37.1); and for those older than 80 years of age, it was 40.0 (95% CI, 32.9-47.1). The ADR in women younger than 50 years old was 12.6 (95% CI, 6.8-18.4); in those 50 to 59 years of age, it was 17.0 (85% CI, 15.9-18.1); for those 60 to 69 years of age, it was 22.4 (95% CI, 20.8-24.0); for those 70 to 79 years of age, it was 26.1 (95% CI, 23.7-28.5); and for those older than 80 years of age, it was 26.9 (95% CI, 21.4-32.5). Limitations The Clinical Outcomes Research Initiative database offers access to demographic information as well as endoscopy and pathology data, but there is limited clinical information about patients in the database. Conclusion The ADR, and, importantly, the rate of advanced neoplasia increased with each decade of life after the age of 50 and are higher in men than women in each decade of life.
•The effect of a coal mill classifier speed was measured online in a 660 MWe plant.•The coal particle fineness and the coal flow distribution were monitored.•The amount of particles <75 µm varied ...between 66 and 74%.•The maximum coal flow deviation was reduced from 14% to 9%.
The fineness of the coal powder and the uniformity of the coal flow sent to the burners are crucial parameters to achieve an effective combustion in coal-fired power plants. This study presents a methodology for the online monitoring of the (i) coal particle size distribution and (ii) coal flow distribution between burners at the outlet of a roller mill installed in 660 MWe coal-fired power plant. The effect of a varying centrifugal classifier speed on these two properties was investigated. To the best knowledge of the authors, it is the first time that such an effect is monitored online in a large scale utility boiler. For a classifier speed between 73 and 99 rpm, the mass fraction of particles smaller than 75 µm varied between 66 and 74%. The coal flow distribution between burners was strongly improved when the particle size was the smallest: the maximum deviation from the average flow rate was reduced from 14% at 73 rpm to 9% at 99 rpm.
Abstract Objective This study investigates whether health disparities exist in infants with hypertrophic pyloric stenosis (HPS), to identify factors affecting definitive treatment, and if more ...morbidity occurs. Methods A six-year retrospective analysis was performed on infants with HPS. Analysis of variance was used to evaluate the impact of socioeconomic factors on disease severity and hospitalization. General linear models were used to assess the impact of risk factors on the outcomes. Results There were a total of 584 infants. African-American’s had lower serum chloride ( p <0.001), higher bicarbonate ( p =0.001), and sodium levels ( p =0.006), adding to longer hospitalization than Whites ( p =0.03). Uninsured infants had lower sodium and chloride ( p <0.001) and higher bicarbonate ( p <0.001), resulting in a longer time to operation ( p =0.05) than privately insured infants. In multivariable analyses, African-American’s were associated with chloride ( p =0.002) and higher bicarbonate ( p =0.009) and uninsured status remained significantly associated with all electrolyte abnormalities. Conclusions African-American and poorly insured infants with HPS had greater risk of metabolic derangements. This required more time to correct dehydration and electrolytes, adding to longer hospitalizations.
A recently developed portable, on-line capability for γ-ray and conversion-electron spectroscopy, HIGH-TATRA is demonstrated with its application to the study of 183Hg → 183Au at ISOLDE. Key details ...of the low-energy level scheme of the neutron-deficient nuclide 183Au populated in this decay are presented. A broad energy germanium detector is employed to achieve this (the first-ever use of such a device in decay-scheme spectroscopy), by way of a combination of high-gain γ-ray singles spectroscopy and γ-γ coincidence spectroscopy. Further, by combining the γ-ray detectors with a liquid-nitrogen-cooled Si(Li) detector operated under high vacuum, conversion-electron singles and e-γ coincidences are obtained. These data lead to the determination of transition multipolarities and the location of a highly converted (E0 + M1 + E2) transition in the 183Au decay scheme, suggesting a possible new shape coexisting structure in this nucleus. Identification of new intruder and normal states fixes their relative energies in 183Au for the first time. New systematic features in the odd-Au isotopes are presented.
Background Celiac disease (CD) is common but underdiagnosed in the United States. Serological screening studies indicate that, although CD occurs at the same frequency in both sexes, women are ...diagnosed more frequently than men (2:1). CD is less frequently diagnosed among black patients, though the seroprevalence in this group is not known. Objective To measure the rates of duodenal biopsy during EGD for symptoms consistent with CD. Design Retrospective cohort study. Setting Clinical Outcomes Research Initiative National Endoscopy Database, spanning the years 2004 through 2009. Patients Adults undergoing EGD for the indication of diarrhea, anemia, iron deficiency, or weight loss, in which the endoscopic appearance of the upper GI tract was normal. Main Outcome Measurement Performance of duodenal biopsy. Results Of 13,091 individuals (58% female patients, 9% black patients) who met the inclusion criteria, duodenal biopsy was performed in 43%, 45% of female patients and 39% of male patients ( P < .0001). Black patients underwent duodenal biopsy in 28% of EGDs performed compared with 44% for white patients ( P < .0001). On multivariate analysis, male sex (odds ratio OR 0.81; 95% CI, 0.75-0.88), older age (OR for 70 years and older compared with 20-49 years, 0.51; 95% CI, 0.46-0.57), and black patients (OR 0.55; 95% CI, 0.48-0.64) were associated with decreased odds of duodenal biopsy. Limitations Lack of histopathologic correlation with CD prevalence. Conclusions In this multiregional endoscopy database spanning the period from 2004 through 2009, rates of duodenal biopsy increased modestly over time, but overall remained low in patients with possible clinical indications for biopsy. Nonperformance of duodenal biopsy during endoscopy may be contributing to the underdiagnosis of CD in the United States.
Background Data on the role of colonoscopy in hematochezia are almost exclusively derived from clinical experience in tertiary care practice. Objective To characterize the patient population who ...received colonoscopy for hematochezia in a consortium of diverse gastroenterology practices. Design Retrospective analysis. Setting Clinical Outcomes Research Initiative Database, 2002 to 2008. Patients Adults undergoing colonoscopy for the indication of hematochezia. Main Outcome Measurements Demographics, comorbidity, practice setting, adverse events, and colonoscopy procedure characteristics and findings. Age-stratified analyses and analyses of inpatient- versus outpatient-performed colonoscopies were also performed. Results A total of 966,536 colonoscopies were performed during the study period, 76,186 (7.9%) were performed for evaluation of hematochezia. The majority of patients were white non-Hispanic men younger than 60 years old who underwent colonoscopy at a community practice site (79.1%) and had a low-risk American Society of Anesthesiologists (ASA) score (81.5%), in whom colonoscopy reached the cecum (94.8%), and serious adverse events were rare. Colonoscopy findings were hemorrhoids (64.4%), diverticulosis (38.6%), and polyp or multiple polyps (38.8%). From the overall cohort, 38.3% were 60 years of age and older. The older age cohort had significantly more white non-Hispanic females, high-risk ASA scores, incomplete colonoscopies, and unplanned events. Colonoscopy findings demonstrated significantly higher rates of diverticulosis, polyp or multiple polyps, mucosal abnormality/colitis, tumor, and solitary ulcer ( P < .0001). There were 3941 (5.2%) who underwent inpatient-performed colonoscopy. One third of this cohort (32.6%) was defined as having a high ASA score. Limitations Retrospective database review. Conclusions These results describe patient populations and characterize colonoscopy findings in individuals presenting with hematochezia primarily in a community practice setting.
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