| | Colonoscopy Completion and Complications
Purpose
To determine the completion rate and complication rate of colonoscopy at Gundersen Lutheran.
Background
Nearly 5000 colonoscopies are performed each year at Gundersen Lutheran, making this one of the most common technical procedures within our organization. Colonoscopy is indicated to screen for colon cancer or pre-cancerous adenomatous polyps, and to evaluate symptoms of bleeding, abdominal pain, anemia, diarrhea, and other clinical conditions. Diagnostic colonoscopy is a colonoscopy without any polyps removed or lesions destroyed using cautery. Therapeutic colonoscopy is a colonoscopy with the removal of polyps or the destruction of lesions using cautery. The quality of the colonoscopy examination depends upon complete insertion of the colonoscope, adequate visualization of the colon lining, and limiting the number of complications. Complications are more common following polyp removal and can include perforation of the colon and hemorrhage.
Aims
To compare Gundersen Lutheran colonoscopy completion and complication rates with published rates in the literature. This will provide a baseline against which future improvement efforts can be directed.
Methods/Measures
A concurrent review of completion and complication rates for colonoscopy performed at Gundersen Lutheran was conducted between August 1, 2002 and July 31, 2003. A log of all colonoscopies is maintained, recording procedure completion. Complications are tracked via hospital admissions within 30 days following a procedure. A colonoscopy is considered complete if the colonoscope is inserted to the cecum or ileo-colonic anastomosis in patients who have had colon surgery. Colonic perforation occurs when a hole is inadvertently made through the colon wall. Colonic hemorrhage is defined as bleeding from the colon, which occurs within 30 days of colonoscopy and requires evaluation in the hospital. A Chi-Square and Fisher’s Exact tests were used for comparisons.
Benchmark
Department of Veteran Affairs Medical Centers (1).
Results   
Conclusions
Gundersen Lutheran’s Division of Gastroenterology is better than the benchmark in colonoscopy completion rates (p<0.001) and is similar to the benchmark in colonoscopy complications of hemorrhage and perforation (p=0.803 and p=1.000).
Impact
The demand for colonoscopy is rising and there is increasing interest in the quality outcomes of these procedures. When offered colonoscopy procedures, patients assume they will be performed safely and appropriately. Gundersen Lutheran Division of Gastroenterology is able to demonstrate the provision of complete and safe colonoscopy practices.
Next Steps
The Division of Gastroenterology will continue to monitor colonoscopy completion and complication rates.
Reference
1. Nelson DB, et al. Procedural success and complications of large-scale screening colonoscopy.
Gastrointestinal Endoscopy 2002; 55:307-314.
Activity Leader
Scott Rathgaber, M.D. Division of Gastroenterology.
Acknowledgments
Terri Wick, Gastroenterology Medical Technologist
Pat Kohner, BS, Quality & Performance Improvement
Chris Heiderscheit RN, Quality & Performance Improvement
Michelle Mathiason, MS, Biostatistics |