Effect of acuity level and patient characteristics on bowel preparation quality: a retrospective cohort study of inpatient colonoscopies
Tóm tắt
Colonoscopy is the primary method to detect mucosal abnormalities in the colon, rectum, and terminal ileum. Inadequate bowel preparation is a common problem and can impede successful visualization during colonoscopy. Although studies identified hospitalization as a predictor of inadequate bowel preparation, acuity of care vary greatly within this patient population. The current study aims to examine the effect of patient characteristics and care level predictors on inadequate bowel preparation quality within the inpatient setting. This retrospective study was conducted in a single urban level 1 trauma medical center and included adult patients undergoing diagnostic colonoscopy while admitted in the hospital from January 1, 2015 to June 30, 2020. We examined the level of inpatient care between the General Medical Floor (GMF), Intensive Care Units (ICU) and Telemetry Unit (TU) and assessed this association with bowel preparation quality, adjusting for known and unknown predictors. Of 538 patients undergoing colonoscopy, 47.4% were admitted into TU, 43.7% into GMF and 8.9% into ICU. For the entire sample, 72.7% of patients achieved good or excellent preparation and quality of bowel preparation differed by care level (P = 0.01). Patients from the critical care units were less likely to achieve adequate bowel preparation when compared to GMF (Odds Ratio [OR] 0.36; 95% Confidence Interval [CI] 0.17,0.77), after adjusting for patient characteristics, medications, physical status, and preparation regimen. No significant difference in Bowel Preparation Quality (BPQ) was identified between patients from GMF and TU (OR 0.96; 95%CI 0.61, 1.52). Furthermore, adequate BPQ was associated with withdrawal time and cecal intubation, but not higher adenoma detection rates. Results suggest the ICU setting is an independent predictor for inadequate bowel preparation and patients with prior opioid and laxative use may be more likely to have inadequate bowel preparation in the hospital. Future interventions should prioritize preprocedural clinician meetings for critical care unit patients, including a more detailed readiness assessment and thorough medication history.
Tài liệu tham khảo
Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145–64.
American Gastroenterological Association. Statement from the U.S. Multisociety Task Force on Colorectal Cancer. 2018; https://gastro.org/press-releases/statement-from-the-u-s-multisociety-task-force-on-colorectal-cancer/. Accessed 25 Aug 2021.
Gkolfakis P, Tziatzios G, Papanikolaou IS, Triantafyllou K. Strategies to improve inpatients’ quality of bowel preparation for colonoscopy: a systematic review and meta-analysis. Gastroenterol Res Pract. 2019;2019:5147208.
Baker FA, Mari A, Nafrin S, et al. Predictors and colonoscopy outcomes of inadequate bowel cleansing: a 10-year experience in 28,725 patients. Ann Gastroenterol. 2019;32(5):457–62.
Mahmood S, Farooqui SM, Madhoun MF. Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2018;30(8):819–26.
Ness RM, Manam R, Hoen H, Chalasani N. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol. 2001;96(6):1797–802.
Froehlich F, Wietlisbach V, Gonvers JJ, Burnand B, Vader JP. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc. 2005;61(3):378–84.
Yadlapati R, Johnston ER, Gregory DL, Ciolino JD, Cooper A, Keswani RN. Predictors of inadequate inpatient colonoscopy preparation and its association with hospital length of stay and costs. Dig Dis Sci. 2015;60(11):3482–90.
Lebwohl B, Wang TC, Neugut AI. Socioeconomic and other predictors of colonoscopy preparation quality. Dig Dis Sci. 2010;55(7):2014–20.
McNabb-Baltar J, Dorreen A, Al Dhahab H, et al. Age is the only predictor of poor bowel preparation in the hospitalized patient. Can J Gastroenterol Hepatol. 2016;2016:2139264.
Zad M, Do CN, Heffernan A, Johnston L, Al-Ansari M. Factors affecting bowel preparation adequacy and procedural time. JGH Open. 2020;4(2):206–14.
Fuccio L, Frazzoni L, Spada C, et al. Factors that affect adequacy of colon cleansing for colonoscopy in hospitalized patients. Clin Gastroenterol Hepatol. 2021;19(2):339-348.e337.
Jawa H, Mosli M, Alsamadani W, et al. Predictors of inadequate bowel preparation for inpatient colonoscopy. Turk J Gastroenterol. 2017;28(6):460–4.
Tariq H, Kamal MU, Sapkota B, et al. Evaluation of the combined effect of factors influencing bowel preparation and adenoma detection rates in patients undergoing colonoscopy. BMJ Open Gastroenterol. 2019;6(1):e000254.
American Society of Anesthesiologists. ASA Physical Status Classification System,. 2020 https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system. Accessed 10 Feb 2022.
Kastenberg D, Bertiger G, Brogadir S. Bowel preparation quality scales for colonoscopy. World J Gastroenterol. 2018;24(26):2833–43.
Johnson DA, Barkun AN, Cohen LB, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology. 2014;147(4):903–24.
Ergen WF, Pasricha T, Hubbard FJ, et al. Providing hospitalized patients with an educational booklet increases the quality of colonoscopy bowel preparation. Clin Gastroenterol Hepatol. 2016;14(6):858–64.
Grassini M, Verna C, Niola P, Navino M, Battaglia E, Bassotti G. Appropriateness of colonoscopy diagnostic yield and safety in guidelines. World J Gastroenterol. 2007;13(12):1816–9.
Liu A, Yan S, Wang H, et al. Ward nurses-focused educational intervention improves the quality of bowel preparation in inpatients undergoing colonoscopy A CONSORT-compliant randomized controlled trial. Medicine (Baltimore). 2020;99(36):e20976.
Shah-Khan SM, Cumberledge J, Reynolds GJ. Using the plan-do-study-act approach to improve inpatient colonoscopy preparation. BMJ Open Qual. 2017;6(2):e000230.