Post-holiday colonoscopies more likely to have inadequate bowel prep
SAN DIEGO — Patients undergoing colonoscopy in the days following state holidays and early in the week more often presented with inadequate bowel preparation, according to a presenter at Digestive Disease Week 2019.
“We showed that having a colonoscopy on the day after a holiday has a higher chance of inadequate bowel preparation,” Ammar Nassri, MD, of the department of medicine, division of gastroenterology and hepatology at University of Florida-Jacksonville, said during his presentation. “We also showed that colonoscopy on certain days of the week or toward the end of the week had a better bowel preparation.”
Nassri and colleagues aimed to look at timing factors associated with inadequate bowel preparation. Specifically, they considered days following holidays, day of the week and time of day. As a secondary outcome, they hoped to identify other non-modifiable variables that could be more easily assessed than those previously identified by other studies.
The researchers included patients aged older than 18 years who received outpatient colonoscopy at the center between 2013 and 2016, regardless of indication (n = 6,510). They defined quality bowel preparation as 6 or greater on the Boston Bowel Preparation Scale (BBPS) or better than or equal to ‘Fair’ according to the Aronchick scale. They collected demographics, time of colonoscopy, days of the week and day after holiday for each colonoscopy.
All procedures completed on the business day after a state holiday were marked as ‘DAH.’ The study included New Years, Martin Luther King Day, Memorial Day, Independence Day, Labor Day, Veterans Day, Thanksgiving and Christmas.
“Almost 46% had inadequate bowel preparation,” Nassri said.
Breaking it down by DAH, Nassri showed that 55.4% of patients who underwent colonoscopy DAH had inadequate bowel preparation compared with 45.7% overall (P = .006), resulting in a OR of 1.5 (95% CI, 1.1-1.9).
“In looking at the holiday subtype, the days at the highest rate of inadequate bowel preparation were MLK and Labor Day. Interestingly, Christmas and Thanksgiving had among the lowest rates of inadequate bowel preparation,” Nassri said.
“In looking at the time of day, we see that the adequate bowel preparation rates are highest in the morning and they go down as the day progresses. Similarly, the inadequate bowel preparation rates are lowest in the morning and they go up as the day goes on,” he added. The was a significant trend (P < .001).
Women had a higher adequate bowel preparation rate than men (57% vs. 50%; P < .001) and white people had the highest rates of inadequate bowel preparation, at 48% compared with 45% in black people and 24% in other races, Nassri said.
“As expected, our commercially insured patients had the most adequate bowel preparation at 65%,” Nassri said. “The bowel preparation rates for city contract, state Medicaid and Medicare were all equally poor.”
Though Nassri and colleagues theorized Monday would produce the lowest rates of adequate bowel prep, they were surprised to see that trend last through Wednesday.
“We can see the highest rates of adequate preparation were toward the end of the week on Thursday and Friday,” he said.
Nassri concluded by suggesting that each health care system should analyze its patient population to see what can improve the overall bowel preparation.
“We have implemented educational measures to decrease inadequate bowel preparation with targeted media intervention,” he said. “We are currently working on prediction models to identify high-risk patients to see if scheduling them earlier in the day, later in the week and not around holidays will improve rates of adequate bowel preparation.” – by Katrina Altersitz
Nassri A, et al. Abstract #515. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.
Disclosures: Nassri reports no relevant financial disclosures.