Evaluation of colonoscopy performance based on post-procedure bleeding complications: application of procedure...

Area of Science:

• Gastroenterology
• Medical Quality Assurance
• Health Services Research

Background:

• Colonoscopy quality assurance is challenged by rare complications and varying procedure complexity.
• Accurate evaluation of individual colonoscopist complication rates is difficult.
• There is a need for a system that adjusts for procedure complexity in quality monitoring.

Purpose of the Study:

• To develop a quality system that adjusts for procedure complexity.
• To monitor bleeding adverse events at screening center and colonoscopist levels.
• To objectively identify centers or colonoscopists requiring performance evaluation.

Main Methods:

• Examined risk factors for post-procedure bleeding in 130,831 colonoscopies.
• Used binomial and logistic regression models with variables like age, sex, and polyp characteristics.
• Developed a procedure-adjusted standardized adverse event ratio (PASAER) based on observed vs. expected events.

Main Results:

• Bleeding risk associated with largest resected polyp size, sex, polyp location, and co-morbidity.
• Calculated PASAERs for 59 centers and 286 colonoscopists.
• Identified one center with a high PASAER (3.08) and one with a low PASAER (0.34) for further investigation.

Conclusions:

• PASAER provides certainty that adverse event rates are not confounded by procedure complexity.
• The system objectively identifies centers or colonoscopists needing performance evaluation.
• This approach enhances the reliability of colonoscopy quality assurance.