Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy

Abstract

BackgroundRisk factors for poor bowel preparation are recognized to be independent of the type of bowel preparation method used. Patient and administrative factors influencing bowel preparation are known to vary in different healthcare systems.MethodsA prospective, cross-sectional study of patients undergoing colonoscopy in an Asian tertiary centre was conducted to identify risk factors associated with poor bowel preparation, and to evaluate the impact of poor bowel preparation on technical performance and patient comfort.ResultsData on 501 patients (mean age 60.1 ± 14.0 years old, 51.2% males, 60.9% with secondary education or higher) was available for analysis. Poor bowel preparation was present in 151 patients (30.1%). Lower education level (OR = 2.35, 95% CI = 1.54 - 3.60), colonoscopy appointment waiting time beyond 16 weeks (OR = 1.86, 95% CI = 1.04 - 3.37) and non-adherence to bowel preparation instructions (OR = 4.76, 95% CI = 3.00 - 7.55) were identified as independent risk factors for poor bowel preparation. Poor bowel preparation was associated with a lower cecal intubation rate (78.1% versus 98.3%, p < 0.001), prolonged total colonoscopy time (25.4 ± 12.6 minutes versus 16.7 ± 10.2 minutes, p < 0.001), and increased patient discomfort during colonoscopy (patient with moderate to severe abdominal discomfort 31.8% versus 3.2%, p < 0.001).ConclusionsEducation levels and appointment waiting times, in addition to non-adherence to bowel preparation instructions, increase the risk of poor bowel preparation in adult patients undergoing colonoscopy. The latter has a significant impact on colonoscopy performance and patient comfort.

Factors influencing quality of bowel preparation for colonoscopy

“…In a retrospective United States study of 300 patients, univariate analysis demonstrated that a mean age of ≥ 66 years was predictive of poor colonoscopy preparation [60] . In two recent Asian studies, age ≥ 60 years were similarly associated with a poor bowel preparation [27,54] . An increased age is known to be associated with a reduced colonic transit, greater co-morbidity and polypharmacy, all of which are known to impact on colonic cleansing [39,[61][62][63][64] .…”

“…Studies in both the West [65,66] and the East [67] have demonstrated that male gender is an independent predictor of poor bowel preparation. Among 649 American patients, of whom 21.7% had poor bowel preparation, Ness et al [65] reported that male gender was an independent predictor of poor bowel preparation among other patient-related factors.…”

“…Colonoscopy performance is also significantly affected by poor bowel preparation. In a recent study among Asian patients, poor bowel preparation resulted in decreased cecal intubation, prolonged cecal intubation and total colonoscopy time, and increased patient discomfort [27] . In similar studies in Europe and Australia, poorly prepared patients during colonoscopy had longer, more difficult procedures and a lower diagnostic yield for polyps [28][29][30] .…”

Shorter waiting times from education to colonoscopy can improve the quality of bowel preparation: A randomized controlled trial

“…First, it did not assess patients' socioeconomic status or education level, which are also potential factors affecting the quality of bowel preparation (10,11,24). Second, since we evaluated bowel preparation for afternoon colonoscopy, these results may not apply to morning colonoscopy.…”

“…Many studies have reported risk factors associated with inadequate bowel preparation (5-9); however, the relationship between the waiting time from education to colonoscopy and risk of inadequate bowel preparation has not been studied in detail. Chan et al (10) reported that appointment waiting times influenced the quality of bowel preparation, and a prolonged appointment waiting time of >16 weeks was associated with poor bowel cleansing (odds ratio: 1.86, P=.035). Another retrospective study (11) in the United States did not identify waiting time as a risk factor for poor bowel cleansing, but in this study the mean waiting time was 4.3 weeks.…”