Document Detail

Sedation in screening colonoscopy: impact on quality indicators and complications.
MedLine Citation:
PMID:  23147522     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Quality indicators including cecal intubation rate (CIR) and adenoma detection rate (ADR) are established. Sex differences of quality indicators are observed, but the influence of sedation has not been investigated so far. The objective of this study is to assess the impact of sedation on quality indicators, including CIR and ADR, according to sex.
METHODS: We analyzed data of 52,506 screening colonoscopies performed by 196 endoscopists between November 2007 and April 2011 according to the Austrian "quality management for colon cancer prevention" program.
RESULTS: Sedation did not affect polyp detection rate (women P=0.7972, men P=0.3711) or ADR for both sexes (women P=0.2773, men P=0.8676). ADR was not significantly influenced by sedation (P=0.1272), but by age and sex (both P<0.0001), when the executing endoscopist was considered. Although women were more often sedated than men (90.70 vs. 81.83%; P<0.0001), CIR was slightly lower in women than in men (94.69 vs. 96.58%; P<0.0001). Sedation improved the CIR in women by 2.95% (94.96 vs. 92.01%; P<0.0001), whereas in men it was just by 1.28% (96.81 vs. 95.53%; P<0.0001). Sedated women only reached the CIR of unsedated men (94.96 vs. 95.53%; P=0.1005). Accounting for the intra-observer influence of the endoscopist, the overall CIR was influenced by the interaction of sex and age (P=0.0049), but not by sedation (P=0.1435).
CONCLUSIONS: Sedation does not increase adenoma or polyp detection, although it leads to an increase in CIR in men and women. This effect is more pronounced in women, yet CIR of men remains higher compared with women. Quality indicators are mainly influenced by the patient's age, sex, and the endoscopists' individual performance, rather than the endoscopists' subspeciality or procedural experience.
Christina Bannert; Karoline Reinhart; Daniela Dunkler; Michael Trauner; Friedrich Renner; Peter Knoflach; Arnulf Ferlitsch; Werner Weiss; Monika Ferlitsch
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-11-13
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  107     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-05     Completed Date:  2013-01-28     Revised Date:  2013-06-18    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1837-48     Citation Subset:  IM    
Quality Assurance Working Group of Austrian Society for Gastroenterology and Hepatology, Vienna, Austria.
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MeSH Terms
Adenoma / diagnosis
Age Factors
Clinical Competence
Colonic Neoplasms / diagnosis*,  prevention & control
Colonic Polyps / diagnosis
Colonoscopy / methods*,  standards*
Conscious Sedation*
Mass Screening / methods*,  standards*
Middle Aged
Quality Indicators, Health Care*
Sex Factors
Comment In:
Am J Gastroenterol. 2013 May;108(5):853   [PMID:  23644966 ]
Am J Gastroenterol. 2013 May;108(5):853-4   [PMID:  23644965 ]
Endoscopy. 2013;45(4):305-9   [PMID:  23533077 ]
Am J Gastroenterol. 2012 Dec;107(12):1849-51   [PMID:  23211852 ]

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