P1462 - Are Quality Metrics Altered in Screening Colonoscopies With Fellow Participation?

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Meredith Yellen, MD

University of Illinois at Chicago
Chicago, IL, United States

Meredith Yellen, MD¹, Jeffrey Rebhun, MD¹, Yinglin Xia, PhD², Asim Shuja, MD¹
¹University of Illinois at Chicago, Chicago, IL; ²University of Illinois at Chicago, Chicago,, IL

Introduction: - Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer-related deaths in the United States amongst both men and women. In an effort to improve screening for CRC, a series of quality performance indicators have been introduced to better quantify endoscopist performance. There is discrepant evidence to suggest that fellow-driven procedures can improve quality performance metrics.
The aim of this study is to determine the effect of fellow participation on the Adenoma Detection Rate (ADR) and several alternative quality performance indicators in screening colonoscopies.

Methods: - A retrospective review was conducted of all adult patients who underwent outpatient screening colonoscopy at a tertiary health center between January 2015-April 2020

- Patients with a history of CRC, colonic resection, and all diagnostic and surveillance procedures were excluded from the study

- Quality metrics like ADR, Polyp Detection Rate (PDR), Right Sided Polyp Detection Rate (RSP), and Colonoscopy Withdrawal Time (CWT) were compared between colonoscopies performed by attending physician only and those performed by fellows with attending supervision.

Results: - A total of 1,884 colonoscopies were included in our quantitative and qualitative analysis. There was no significant difference between age, ethnicity, or time of day between the two groups, additionally, there was no significant difference in ADR for attending-only procedures (47% + .02) and those by fellows with attending supervision (46% + .02, P = 0.69). Likewise, (PDR) for attendings (66% + .01) was not found to be significantly different than procedures including fellows (63% + .02, P= 0.31). RSP was, however, significantly different for attending only procedures (47% + .02) compared to attendings with fellows (43% + .02, P= 0.04). Similarly, CWT was found to be significantly longer with procedures that included fellows (16.12 + .3 minutes) than for those only involving attending physicians (15.56 + .3 minutes, p = .02)

Discussion: - Our results suggest that there is no significant difference in ADR or PDR with fellow involvement in screening colonoscopies. It appears, fellow involvement does, however, significantly decrease right sided polyp (RSP) detection rate and increase the CWT. Further studies are required to make definitive conclusions regarding fellow participation and its effect on performance indicators.

Variable	Attending Only		Fellow Participation		P-Value
	Mean	SE	Mean	SE
ADR	0.47	0.02	0.46	0.02	0.69
APC	0.88	0.05	1.05	0.06	0.44
PDR	0.66	0.01	0.63	0.02	0.31
RSP	0.47	0.02	0.43	0.02	0.04
Withdrawal Time	15.56	0.30	16.12	0.30	0.02

Table: Table 1: Comparison in quality metrics for colonoscopies done by an attending alone and with fellow involvement

Disclosures:
Meredith Yellen indicated no relevant financial relationships.
Jeffrey Rebhun indicated no relevant financial relationships.
Yinglin Xia indicated no relevant financial relationships.
Asim Shuja indicated no relevant financial relationships.

Meredith Yellen, MD¹, Jeffrey Rebhun, MD¹, Yinglin Xia, PhD², Asim Shuja, MD¹. P1462 - Are Quality Metrics Altered in Screening Colonoscopies With Fellow Participation?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.