Department of Medicine, University of Washington, Seattle, Washington 98195, USA.
Am J Gastroenterol. 2010 Dec;105(12):2670-9. doi: 10.1038/ajg.2010.344. Epub 2010 Aug 24.
Early repeat colonoscopy after an index examination may be justifiable, but may also reflect quality issues during the first examination. The aims of this study were to examine the use of second colonoscopy within 1 year of an index colonoscopy, and to examine patient and provider factors associated with use of early repeat colonoscopy.
We performed a retrospective cohort study using a 20% nationally representative sample of 2003 Medicare claims. Patients aged ≥ 66 years undergoing colonoscopy were included in this study. We identified the use of second colonoscopy and barium enema within 1 year of the index procedure. We used logistic regression analyses to examine the independent predictors of these procedures.
We included 328,167 outpatient colonoscopies. In all, 5% had second colonoscopy and 2.2% had barium enema within 1 year of the index examination. Early repeat colonoscopy was more common if the index examination was performed by a family physician (odds ratio 1.39, 95% confidence interval 1.23-1.56), general surgeon (odds ratio 1.18, 95% confidence interval 1.10-1.27) or internist (odds ratio 1.12, 95% confidence interval 1.02-1.23) compared with a gastroenterologist, or after colonoscopies by an endoscopist in the lower quartiles of colonoscopy volume compared with endoscopists in the highest quartile. Increasing patient age and comorbidity, polyp detection, biopsy, polyp removal, incomplete index examination, and site of service were also significantly associated with early repeat colonoscopy.
Early repeat colonoscopy is not unusual. The association of specialty and colonoscopy volume with early repeat colonoscopy suggests that there are modifiable processes of care or training that may prevent some of these repeat procedures.
在初次检查后进行早期重复结肠镜检查可能是合理的，但也可能反映初次检查过程中的质量问题。本研究的目的是检查在初次结肠镜检查后 1 年内进行第二次结肠镜检查的情况，并检查与早期重复结肠镜检查相关的患者和提供者因素。
我们使用全国范围内 20%的 2003 年 Medicare 索赔记录的 20%的代表性样本进行了回顾性队列研究。本研究纳入了年龄≥66 岁且接受结肠镜检查的患者。我们确定了在初次检查后 1 年内进行第二次结肠镜检查和钡灌肠的情况。我们使用逻辑回归分析来检查这些程序的独立预测因素。
我们纳入了 328167 例门诊结肠镜检查。总体而言，5%的患者在初次检查后 1 年内进行了第二次结肠镜检查，2.2%的患者进行了钡灌肠。如果初次检查由家庭医生（优势比 1.39，95%置信区间 1.23-1.56）、普通外科医生（优势比 1.18，95%置信区间 1.10-1.27）或内科医生（优势比 1.12，95%置信区间 1.02-1.23）进行，而不是由胃肠病学家进行，或者与处于最低四分位数的结肠镜检查量的内镜医生相比，与处于最高四分位数的内镜医生相比，早期重复结肠镜检查更常见。患者年龄和合并症增加、息肉检出、活检、息肉切除、不完全的索引检查以及服务地点也与早期重复结肠镜检查显著相关。
早期重复结肠镜检查并不罕见。专业和结肠镜检查量与早期重复结肠镜检查的关联表明，可能存在可修改的护理或培训过程，可以预防其中一些重复程序。
