Polypectomy rate is a valid quality measure for colonoscopy: results from a national endoscopy database.

BACKGROUND

The adenoma detection rate (ADR) is one of the main quality measures for colonoscopy, but it is burdensome to calculate and is not amenable to claims-based reporting.

OBJECTIVE

To validate the correlation between polypectomy rates (PRs) and ADRs by using a large group of endoscopists.

DESIGN

Retrospective study.

SETTING

Community and academic endoscopy units in the United States.

SUBJECTS

Sixty endoscopists and their patients.

MAIN OUTCOME MEASUREMENTS

Proportion of patients with any adenoma and any polyp removed; correlation between ADRs and PRs.

RESULTS

In total, 14,341 screening colonoscopies were included, and there was high correlation between endoscopists' PRs and ADRs in men ( r(s)= .91, P < .0001) and women (r(s) = .91, P < .0001). Endoscopists with PRs in the highest quartile had a significantly higher ADR than did those in the lowest quartile in men (44.6% vs 19.4%, P < .0001) and women (33.6% vs 11.6%, P < .0001). Endoscopists in the top polypectomy quartile also found more advanced adenomas than did endoscopists in the bottom quartile (men: 9.6% vs 4.6%, P = .0006; women: 6.3% vs 3.0%, P = .01). Benchmark PRs of 40% and 30% correlated with ADRs greater than 25% and 15% for men and women, respectively.

LIMITATION

Retrospective analysis of a subset of a national endoscopic database.

CONCLUSIONS

Endoscopists' PRs correlate well with their ADRs. Given its clinical relevance, its simplicity, and the ease with which it can be incorporated into claims-based reporting programs, the PR may become an important quality measure.