RT Journal Article
SR Electronic
T1 Repeat colonoscopy after a colonoscopy with a negative result in Ontario: a population-based cohort study
JF CMAJ Open
FD Canadian Medical Association
SP E244
OP E250
DO 10.9778/cmajo.20140063
VO 3
IS 2
A1 Lieke Hol
A1 Rinku Sutradhar
A1 Sumei Gu
A1 Nancy N. Baxter
A1 Linda Rabeneck
A1 Jill M. Tinmouth
A1 Lawrence F. Paszat
A1 the investigators of the Ontario Cancer Screening Research Network
YR 2015
UL http://www.cmajopen.ca/content/3/2/E244.abstract
AB Background Data suggest the overuse of repeat colonoscopies, especially in patients at low risk for colorectal cancer. Our objective was to evaluate the time to repeat colonoscopies in low-risk patients aged 50–79 years old and the associated patient- and endoscopist-related factors. Methods All patients aged 50–79 years of age who underwent a complete outpatient colonoscopy with a negative result between 2000 and 2007 were identified from the Ontario Health Insurance Plan database. A colonoscopy performed within 5.5 years of follow-up after the index colonoscopy was considered an early repeat colonoscopy. Patient, endoscopist and endoscopy setting characteristics were recorded and their association with an early repeat colonoscopy was determined using an extended Cox proportional hazards regression model.Results The cohort consisted of 546 467 patients: 55.4% of the patients were female with a mean age of 61.1 years (95% confidence interval [CI] 61.1–61.2). The cumulative percentage of early repeat colonoscopy after 5.5 years was 33.7%. The rate decreased significantly between 2000 and 2007 (hazard ratio [HR] 0.35, 95% CI 0.34–0.36). General surgeons were associated with a higher risk of early repeat colonoscopy than gastroenterologists (HR 1.27, 95% CI 1.25–1.28). Endoscopists practising in a nonhospital setting were more likely to perform an early repeat colonoscopy (HR 1.26, 95% CI 1.22–1.30) than endoscopists at a hospital.Interpretation This study showed that there was overuse of early repeat colonoscopy in more than 30% of patients who were at low risk for colorectal cancer. The risk decreased significantly between 2000 and 2007 but was still greater than 20% in 2007. Our findings can be used to develop targeted educational interventions among subgroups of endoscopists with a higher rate of early repeat colonoscopy.