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Sunday Poster Session

Category: Colon

P0187 - Delays in Inpatient Colonoscopy: An Opportunity to Intervene?

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall
ACG Outstanding Poster Presenter
Monica Dzwonkowski, DO1, Shivani K. Desai, MD1, Shriraj Patel, DO1, Deepa Kumarjiguda, DO1, Umair Iqbal, MD1, Tian Guo, MS1, Patrick May, MS2, Matthew Joshua. Shellenberger, DO1
1Geisinger Medical Center, Danville, PA; 2Geisiger Medical Center, Danville, PA

Introduction: Delays in performing procedures can lead to increased healthcare costs. Our study aimed to evaluate the impact of delays in inpatient colonoscopy on length of stay (LOS) to identify potential modifiable factors to reduce delays to procedure.

Methods: This retrospective study involved a review of inpatient colonoscopies conducted at a tertiary care center between January 1st, 2019 to December 31st, 2019. Delays were defined as >1 day from inpatient gastroenterology consult to procedure completion. Indication for colonoscopy was classified into six distinct groups and reason for delay was categorized into eight groups (Table 1). Comparison between delay vs no delay was performed using Chi-square and Fisher-exact test for categorical variables and Wilcoxon rank test for continuous variables. An analysis of variance test was performed to assess differences in length of stay for reasons for delay.

Results: A total of 979 cases were identified (mean age 66.8 years, 54.4% male, 96% Caucasian) with 51% (n=500) exhibiting a delay to procedure. There was no significant difference among demographics including sex, race, age, or BMI, nor prep quality (adequate vs inadequate). Delay in colonoscopy led to a longer LOS (2 days v 4 days, P=< 0.01). Bleeding was the most common indication for inpatient colonoscopy. Days from consult to colonoscopy, LOS, the indications for procedure, and the reason for delay revealed a statistically significant association with delay. The most common reasons for delay included weekend consults (25%) and performance of alternate procedures such as EGD first (26.2%). There was no significant difference between delayed and non-delayed patients for any significant endoscopic findings. The results indicate that there is a statistically significant difference in length of stay among all the various reasons for delay (p< 0.01).

Discussion: Among nearly 1000 cases, more than half experienced delays in the timing of the colonoscopy procedure resulting in an increased LOS. Nonmodifiable factors such as delayed presentation of bleeding or the use of alternative procedure modalities for workup may not be amenable to intervention. Effort should be made to identify potential modifiable factors such as weekend consults and need for cardiology clearance. Performing weekend procedures and prompt cardiology workup may be justified in certain cases to reduce cost and expedite workup for these patients.
 Total (N=979)Not Delayed (N=479)Delayed (N=500)P-Value
Sex, n (%)
   Female
   Male
446 (45.6%)
533 (54.4%)
232 (48.4%)
247 (51.6%)
214 (42.8%)
286 (57.2%)		0.08
Race, n (%)
   White
   African American
   Asian
   Native Hawaiian or other Pacific Islander
   Unknown
940 (96.0%)
28 (2.9%)
7 (0.7%)
1 (0.1%)

3 (0.3%)
461 (96.2%)
11 (2.3%)
4 (0.8%)
1 (0.2%)

2 (0.4%)
479 (95.8%)
17 (3.4%)
3 (0.6%)
0 (0.0%)

1 (0.2%)		0.62
Age at Procedure, Mean (SD)70 (59, 78)66.3 (15.05)67.5 (14.62)0.14
BMI, Median (IQR)28.48 (24.4, 34.0)28.9 (24.2, 34.2)28.34 (24.7, 33.9)0.76
Days Consult to Colonoscopy, Median (IQR)2 (1, 3)1 (1, 1)3 (2, 4)< 0.01
Length of Stay, Median (IQR)3 (2, 6)2 (1, 4)4 (3, 6)< 0.01
Indication
  Bleeding 1
  IDA
  Therapeutic2
  Abnormal Imaging
  Cancer Screening
  IBD
512 (52.3%)
179 (18.3%)
39 (4.0%)
95 (9.7%)
57 (5.8%)
97 (9.9%)
282 (58.9%)
62 (12.9%)
31 (6.5%)
46 (9.6%)
18 (3.8%)
40 (8.4%)
230 (46.0%)
117 (23.4%)
8 (1.6%)
49 (9.8%)
39 (7.8%)
57 (11.4%)		< 0.01
Reason for Delay, n (%)
  None
  Delayed Bleeding3
  Weekend Consult
  Alt. Procedure First4
  Abnormal labs
  Anticoagulation
  Prep Intolerance
  Cardiac Clearance
  Other5
483 (49.3%)
46 (4.7%)
125 (12.8%)
131 (13.4%)
16 (1.6%)
17 (1.7%)
74 (7.6%)
43 (4.4%)
44 (4.5%)
479 (100%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
4 (0.8%)
46 (9.2%)
125 (25.0%)
131 (26.2%)
16 (3.2%)
17 (3.4%)
74 (14.8%)
43 (8.6%)
44 (8.8%)		< 0.01
Prep Quality, n (%)
  Adequate
  Inadequate
563 (57.5%)
416 (42.5%) 
263 (54.9%)
216 (45.1%)
300 (60.0%)
200 (40.0%)		  0.12
Important Finding, n (%)
  Normal/no findings
  Mass/cancer
  Active hemorrhage
  Angioectasia
  IBD
  Diverticulosis
  Ulcer
  Polyp
  Hemorrhoid/fissure
  Abnormal mucosa 
  Other6

56 (5.7%)
66 (6.7%)
102 (10.4%)
53 (5.4%)
19 (1.9%)
363 (37.1%)
32 (3.3%)
93 (9.5%)
85 (8.7%)
45 (4.6%)
65 (6.6%)

30 (6.3%)
37 (7.7%)
63 (13.2%)
20 (4.2%)
9 (1.9%)
160 (33.4%)
14 (2.9%)
40 (8.4%)
48 (10.0%
20 (4.2%)
38 (7.9%)



26 (5.2%)
29 (5.8%)
39 (7.8%)
33 (6.6%)
10 (2.0%)
203 (40.6%)
18 (3.6%)
53 (10.6%)
37 (7.4%)
25 (5.0%)
27 (5.4%)

 0.02
Length of Stay by Reason for Delay, Median (IQR)
  None
  Delayed Bleeding
  Weekend Consult
  Alt. Procedure First4
  Abnormal labs
  Anticoagulation
  Prep Intolerance
  Cardiac Clearance
  Other5


3.5 (2.5, 4)
6.5 (4, 12)
5 (3, 6)
4 (3, 6)
4 (3, 5.5)
5 (4, 5)
4 (4, 6)
5 (4, 7)
4 (3,6) 		  < 0.01

Table: Table 1: Patient demographics and data
1: Bleeding defined as melena or hematochezia
2: Therapeutic colonoscopy for volvulus decompression or fecal transplant
3: Alternate procedure first including EGD, push endoscopy, capsule endoscopy, or flexible sigmoidoscopy
4: Delayed bleeding defined as delay in procedure secondary to stabilization of hemoglobin or lack of hematochezia or melena during initial gastroenterology evaluation
5: Other includes awaiting input from specialist (neurology, surgery), scheduling conflicts, and awaiting patient/family consent
6: Other includes fecal transplant, redundant colon, or evidence of previous surgery

IDA= Iron Deficiency Anemia
IBD= Inflammatory Bowel Disease


Disclosures:
Monica Dzwonkowski indicated no relevant financial relationships.
Shivani Desai indicated no relevant financial relationships.
Shriraj Patel indicated no relevant financial relationships.
Deepa Kumarjiguda indicated no relevant financial relationships.
Umair Iqbal indicated no relevant financial relationships.
Tian Guo indicated no relevant financial relationships.
Patrick May indicated no relevant financial relationships.
Matthew Shellenberger indicated no relevant financial relationships.


Monica Dzwonkowski, DO1, Shivani K. Desai, MD1, Shriraj Patel, DO1, Deepa Kumarjiguda, DO1, Umair Iqbal, MD1, Tian Guo, MS1, Patrick May, MS2, Matthew Joshua. Shellenberger, DO1. P0187 - Delays in Inpatient Colonoscopy: An Opportunity to Intervene?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.