Comparison of Quality Performance Metrics in Screening and Surveillance Colonoscopy: A Single-Center Experience

Abstract

Background and aims: Current guidelines for screening colonoscopies recommend a minimum adenoma detection rate (ADR) of 25%. There are no established benchmarks for surveillance colonoscopies and data surrounding the utility of other quality metrics in this setting is limited. We aimed to define the relationship between ADR and alternative quality measures in the setting of screening and surveillance colonoscopies and determine whether validated screening quality benchmarks can be extrapolated to surveillance procedures. Methods: A retrospective review was conducted of adults who underwent outpatient screening and surveillance colonoscopies at a tertiary health center. ADR, adenomas per colonoscopy (APC), adenomas per positive participant (APP), polyp detection rate (PDR), right-sided polyp detection rate (RSP), and withdrawal times (CWT) were analyzed for screening and surveillance colonoscopies. Normality tests were performed for each continuous variable. Kruskal-Wallis tests were performed to analyze categorical and continuous outcomes. Spearman rank correlations were performed to compare surrogate outcomes to ADR. Results: In total, 2646 procedures, 1884 screening and 762 surveillance, were analyzed. Surveillance ADR (CADR) was significantly higher than screening ADR (SADR) (65.6%+0.02 v. 47.0%+0.01%, p<0.001). All alternate quality measures except CWT were significantly higher in surveillance procedures. Among surveillance procedures, there was a strong correlation between CADR and PDR (r=0.956, p<0.01), as well as RSP (r=0.771, p=0.003); correlations between CADR and other alternate quality measures were not significant. Conclusion: Colonoscopy quality measures were significantly higher in surveillance procedures when compared to screening procedures despite similar CWT. Higher benchmarks must be established to ensure quality surveillance colonoscopies.