Adenoma Detection Rates Decline with Increasing Procedural Hours in an Endoscopist’s Workload

BACKGROUND: Operator fatigue may negatively influence adenoma detection (AD) during screening colonoscopy. OBJECTIVE: To better characterize factors affecting AD, including the number of hours worked, and the number and type of procedures performed before an index screening colonoscopy. METHODS: A retrospective cohort study was conducted involving individuals undergoing a screening colonoscopy at a major tertiary care hospital in Montreal, Quebec. Individuals were identified using an endoscopic reporting database; AD was identified by an electronic chart review. A hierarchical logistic regression analysis was performed to determine the association between patient- and endoscopist-related variables and AD. RESULTS: A total of 430 consecutive colonoscopies performed by 10 gastroenterologists and two surgeons were included. Patient mean (± SD) age was 63.4±10.9 years, 56.3% were males, 27.7% had undergone a previous colonoscopy and the cecal intubation rate was 95.7%. The overall AD rate was 25.7%. Age was associated with AD (OR 1.06 95% CI 1.03 to 1.08), while female sex (OR 0.44 95% CI 0.25 to 0.75), an indication for average-risk screening (OR 0.47 95% CI 0.27 to 0.80) and an increase in the number of hours during which endoscopies were performed before the index colonoscopy (OR 0.87 95% CI 0.76 to 0.99) were associated with lower AD rates. On exploratory univariable analysis, a threshold of 3 h of endoscopy time performed before the index colonoscopy was associated with decreased AD. CONCLUSION: The number of hours devoted to endoscopies before the index colonoscopy was inversely associated with AD rate, with decreased performance possibly as early as within 3 h. This metric should be confirmed in future studies and considered when optimizing scheduling practices.