Michael Castillo, MD1, Adalberto Gonzalez, MD2, Ishtiaq Hussain, MD3, Vaibhav Wadhwa, MD2, Alison Schneider, MD, FACG3
1Cleveland Clinic Foundation, Miami, FL; 2Cleveland Clinic, Weston, FL; 3Cleveland Clinic Foundation, Weston, FL
Introduction: Access to colonoscopy is critical for colorectal cancer screening. Cancelled colonoscopy appointments have a major impact on overall healthcare costs, provider workflow, and delays in colorectal cancer screening and diagnosis. We aimed to discover individual and systemic factors associated with the occurrence of incomplete, missed or cancelled colonoscopy appointments at our institution.
Methods: This was a retrospective observational study using the Cleveland Clinic Florida database. Patients scheduled for screening or diagnostic colonoscopy from January to June 2018 were included. There were two case groups: those that missed or cancelled colonoscopy appointments and those that had incomplete colonoscopies due to poor bowel preparation. A control group consisted of a random sample of 200 patients that had completed colonoscopies during the same time period. We excluded patients that underwent therapeutic colonoscopies. We performed descriptive analysis within each group, univariate analysis between the control group and case groups, and odds ratio. We used a 95% CI and P-values of less than .05 for statistical significance.
Results: 4,499 colonoscopies were scheduled from January to June 2018. There were 369 (8.2%) missed/cancelled colonoscopies and 117 (2.6%) incomplete colonoscopies. Control group included a random sample of 200 completed colonoscopies. The total sample size was 686. Factors associated with a decreased risk of missed colonoscopies included white race (OR .56; p=.001), history of polyps (OR .52, p< 001), previous colonoscopy (OR .32; p< .0001), diagnosis of IBD (OR .21, p=.001), and married status (.52; p=.001) (Table 1). Patients of black race (OR 2.1; p=0.01) and patients with international addresses (OR 2.34; p=0.04) were more likely to have incomplete colonoscopies (Table 2). Incomplete colonoscopies were more likely to be performed and re-scheduled than cancelled colonoscopies (67.5% vs. 44%; p< .001). Monday was the most common day for cancellations (12.6%). Difficulty understanding or tolerating bowel preparation (39.2%) was the most common reason for cancellation (Figure 1).
Discussion: Patient demographics, particularly patients visiting from international locations, were major risk factors for missed and incomplete colonoscopies. Many patients appeared to have difficulty understanding bowel preparation instructions. Future efforts should be made to focus on improving bowel preparation education. This will lead to improvement in healthcare utilization.
Citation: Michael Castillo, MD; Adalberto Gonzalez, MD; Ishtiaq Hussain, MD; Vaibhav Wadhwa, MD; Alison Schneider, MD, FACG. P0214 - DEMOGRAPHIC AND HISTORICAL RISK FACTORS ASSOCIATED WITH INCOMPLETE, MISSED, AND CANCELLED COLONOSCOPIES. Program No. P0214. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.