Is there a "weekend effect" in adenoma detection rate?A single-center retrospective study

The "weekend effect"-inferior patient outcomes on weekends-has been reported across healthcare. Its impact on colonoscopy quality, particularly the adenoma detection rate (ADR), a key predictor of colorectal cancer risk, has not been fully established. This study investigated whether a weekend effect exists for ADR in a large cohort and analyzed potential contributing factors.

This single-center retrospective study included consecutive patients undergoing colonoscopy from January 2022 to December 2023. Patients were categorized into Weekend (Saturday/Sunday) and Weekday (Monday-Friday) groups. The primary outcome was ADR (proportion with ≥1 adenoma). Data on demographics, withdrawal time, Boston Bowel Preparation Scale (BBPS), and endoscopist experience (Junior <5 years, Senior ≥5 years) were collected. Multivariable logistic regression identified factors independently associated with adenoma detection. Stratified analyses by patient subgroups, withdrawal time, and individual endoscopists were performed.

Of 16,550 colonoscopies (4,435 Weekend, 12,115 Weekday), ADR was significantly lower on weekends (24.1% vs. 26.2%, p = 0.006). Median withdrawal time was shorter on weekends (3.61 vs. 4.59 minutes, p < 0.001). After adjustment for confounders, weekend procedures were independently associated with lower ADR (aOR 0.892, 95% CI: 0.821-0.970, p = 0.007), indicating decreased odds of adenoma detection. Other independent predictors included female sex (aOR 0.613, p < 0.001), increasing patient age (aOR 1.050/year, p < 0.001), adequate bowel preparation (BBPS ≥6; aOR 1.407, p < 0.001), and procedure by a senior endoscopist (aOR 1.164, p < 0.001). Subgroup analyses revealed that the weekend effect was significant in specific patient groups compared to their weekday counterparts: females (aOR 0.868, p = 0.022), patients aged 50-59 years (aOR 0.698, p < 0.001), and those with inadequate preparation (BBPS<6; aOR 0.640, p = 0.010). The lower weekend ADR was primarily attributed to two junior endoscopists, with no significant effect observed among senior endoscopists.

A significant weekend effect on ADR was confirmed, principally mediated by shorter withdrawal times and concentrated among junior endoscopists. The effect disproportionately affected women, middle-aged patients, and those with poor bowel preparation. Quality improvement efforts should therefore prioritize enforcing guideline-adherent withdrawal times, optimizing bowel preparation, and providing targeted support to less-experienced endoscopists during weekend services to standardize colonoscopy quality across all days of the week.