P0329 - The Effect of Time of Day on Adenoma Detection Rate

Rachael Schneider, DO, Amanda Long, DO, Julianna Tantum, DO, Patricia Wong, MD, Stephanie Kjelstrom, MPH
Lankenau Medical Center, Wynnewood, PA

Introduction: Adenoma detection rate (ADR) is a key quality metric for screening colonoscopies as it reflects the endoscopist’s ability to detect lesions. ADR is inversely associated with the risk of interval colorectal cancer. The current standard ADR is at least 30% for men and 20% for women. Determining variables which influence ADR is critical to optimizing operator performance. We hypothesized that operator fatigue through the course of a day impacts ADR. We reviewed the ADR of 6 gastroenterologists to determine whether procedure time of day affects ADR.

Methods: An outpatient surgery center database was retrospectively queried. We included all patients aged 40-75 undergoing screening and surveillance colonoscopies from June 1, 2020 to June 30, 2021. Morning procedures were defined as procedures with a start time of 7 am to 12:59 pm. Afternoon procedures were defined as procedures starting at or after 1 pm. ADR was determined for morning procedures and afternoon procedures. Secondary analyses determined the effect of endoscopist age, gender, years of experience, and total number of procedures in a day on ADR.

Results: The total number of colonoscopies included in the study was 2,725. There were 2,201 morning procedures and 524 afternoon procedures. There was no statistically significant difference in ADR for morning compared to afternoon procedures (36.1% vs 36.5%, p =0.888). Because the morning session was 6 hours in duration and afternoon was only 3 hours, ADR was also determined for each successive 3-hour time interval. There was no significant difference in ADR seen between the three time blocks (35.7%, 36.6%, and 36.4%, p=0.906). When examining the effect of operator characteristics on ADR, we found no significant difference in ADR based on endoscopist age. There was a significant difference in ADR between female and male endoscopists (30.6 vs 37.1%, p = 0.001). There was also a significant difference in ADR based on operator experience. ADR was 30.6% for 10-15 years, 43.1% for 16-20 years, and 37.0% for > 20 years of experience (p = < 0.001). There was a trend towards a lower ADR when over 15 procedures were performed in a day.

Discussion: In our study, the time of procedure did not influence the ADR. ADR was significantly lower among the female endoscopists compared to males. ADR was also lower among the least experienced group of physicians. However, our study did not adjust for patient gender or withdrawal time which both impact ADR.



Disclosures:


Rachael Schneider, DO, Amanda Long, DO, Julianna Tantum, DO, Patricia Wong, MD, Stephanie Kjelstrom, MPH. P0329 - The Effect of Time of Day on Adenoma Detection Rate, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.