Numbers matter: How pediatric endoscopy quality varies with annual procedural volume.

Area of Science:

• Pediatric Gastroenterology
• Endoscopic Quality Improvement
• Healthcare Outcomes Research

Background:

• Limited data exists on the link between pediatric endoscopist experience and procedural quality.
• Assessing the impact of faculty physicians' years in practice and annual procedural volume (APV) on pediatric endoscopy quality is crucial.

Purpose of the Study:

• To investigate the association between faculty endoscopist experience (years in practice, APV) and key quality indicators in pediatric endoscopy.
• To determine if specific experience thresholds predict improved procedural outcomes, including terminal ileal intubation rate (TIIR) and cecal intubation rate (CIR).

Main Methods:

• Retrospective analysis of ileocolonoscopies performed by faculty endoscopists at a pediatric tertiary-care academic institution (October 2021 - May 2024).
• Quality indicators defined by the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) were extracted.
• Statistical analyses included Kruskal-Wallis, multivariate modeling, and proportional hazards modeling to assess experience and APV impact on TIIR, CIR, and procedure duration.

Main Results:

• A total of 985 ileocolonoscopies were analyzed, performed by 20 faculty endoscopists with varying experience levels and a median APV of 19.
• An APV of ≥40 ileocolonoscopies annually was a significant predictor for achieving a TIIR of ≥85% (p<0.01).
• More experienced faculty (≥10 years) demonstrated significantly shorter procedure durations compared to those with <10 years of experience.

Conclusions:

• Pediatric endoscopy quality indicators are significantly associated with an individual endoscopist's APV and years of experience.
• Achieving an APV of ≥40 ileocolonoscopies annually may be a benchmark for ensuring high-quality endoscopic procedures in pediatric patients.
• These findings highlight the importance of experience and procedural volume in maintaining pediatric endoscopy quality standards.