Division of Gastroenterology, Duke University School of Medicine, 200 Morris Street, Suite 6524, Durham, NC, 27701, USA.
Durham VA Medical Center, Durham, NC, USA.
Dig Dis Sci. 2021 Aug;66(8):2570-2577. doi: 10.1007/s10620-020-06592-w. Epub 2020 Sep 7.
Variability in colon polyp detection impacts patient outcomes. However, the relative influence of physician, patient, and procedure-specific factors on polyp detection is unclear. Therefore, determining how these factors contribute to adenoma and sessile serrated polyp (SSP) detection is important to contextualize measures of colonoscopy quality such as adenoma detection rate and patient outcomes.
To determine the relative contribution of physician, patient, and procedure-specific factors in total polyp, adenoma, and SSP detection rates.
We performed a retrospective study of patients undergoing screening colonoscopy and used a two-level generalized linear mixed regression model to identify factors associated with polyp detection.
7799 average risk screening colonoscopies were performed between July 2016 and October 2017. The patient factor most strongly associated with increased risk of adenoma and sessile serrated polyp detection was white race (OR 1.21, 95% CI 1.05-1.39 and OR 3.17, 95% CI 2.34-4.30, respectively). Adenomatous (OR 1.92, 95% CI 1.04-3.57) and sessile serrated polyps (OR 5.56, 95% CI 1.37-20.0) were more likely to be found during procedures performed with anesthesia care as compared to those with moderate sedation. Physician with a luminal gastrointestinal focus had increased odds of adenoma detection (OR 1.61, 95% CI 1.02-2.50).
In a multi-level model accounting for clustering effects, we identified patient, provider and procedural factors independently influence adenoma and sessile serrated polyp detection. Our findings suggest that to compare polyp detection rates between endoscopists, even at the same institution, risk adjustment by characteristics of the patient population and practice is necessary.
结直肠息肉检出率的差异会影响患者的结局。然而，医生、患者和操作相关因素对息肉检出的相对影响尚不清楚。因此，确定这些因素如何影响腺瘤和无蒂锯齿状息肉（SSP）的检出率，对于理解结直肠镜检查质量的评估指标（如腺瘤检出率和患者结局）非常重要。
确定医生、患者和操作相关因素对总体息肉、腺瘤和 SSP 检出率的相对贡献。
我们对接受筛查性结肠镜检查的患者进行了回顾性研究，并使用两水平广义线性混合回归模型来确定与息肉检出相关的因素。
2016 年 7 月至 2017 年 10 月期间共进行了 7799 例平均风险筛查性结肠镜检查。与增加腺瘤和 SSP 检出风险最相关的患者因素是白种人种族（OR 1.21，95%CI 1.05-1.39 和 OR 3.17，95%CI 2.34-4.30）。与中度镇静相比，在接受麻醉护理的操作中，腺瘤性息肉（OR 1.92，95%CI 1.04-3.57）和 SSP（OR 5.56，95%CI 1.37-20.0）更有可能被发现。以腔道为重点的胃肠科医生具有更高的检出腺瘤的几率（OR 1.61，95%CI 1.02-2.50）。
在一个考虑到聚类效应的多水平模型中，我们确定了患者、医生和操作因素独立影响腺瘤和 SSP 的检出。我们的研究结果表明，为了在不同内镜医生之间比较息肉检出率，即使是在同一机构，也需要根据患者人群和操作实践的特点进行风险调整。
