Original articleClinical endoscopyAssociation of polypectomy techniques, endoscopist volume, and facility type with colonoscopy complications
Section snippets
Data sources
Ambulatory surgery and inpatient hospital discharge datasets were obtained from the Florida Agency for Health Care Administration for 1997 through 2004. Both datasets were at the encounter level and included unique patient and physician identifiers, primary and secondary diagnoses as classified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), primary and secondary procedure codes based on Current Procedural Terminology (CPT), payer types,
Descriptive analyses
Among the more than 2 million colonoscopies in the sample, 44.38% were simple colonoscopies, 12.64% involved the use of cold biopsy forceps, 2.25% were ablations, 14.95% involved the use of hot biopsy forceps, 17.41% involved the use of snaring, and 8.37% were complex colonoscopies (Table 1). Low-volume endoscopists provided, on average, 179 simple colonoscopies, 177 colonoscopies with cold biopsy forceps, 180 colonoscopies with ablation, 183 colonoscopies with hot biopsy forceps, 188
Discussion
Analyses of all-encounter, all-payer data covering the entire population of Florida for a 7-year period provide an important advancement over previous studies that examined a limited number of facilities or health systems,4, 16, 17 used restricted datasets such as Medicare7 or Medicaid-only data,18 or were non-U.S. based.8, 19 As the complexity of polypectomy increases, a higher risk of adverse events was found in this study.
Simple colonoscopy without cautery is associated with the fewest
Acknowledgments
The authors thank Dr Theodore R. Levin, research scientist at the Kaiser Permanente Northern California Division of Research, gastroenterologist at Kaiser Permanente Medical Center, Walnut Creek, and assistant clinical professor of medicine, University of California, San Francisco, and Dr Doumit BouHaidar, Associate Professor of Medicine, Director of Advanced Therapeutic Endoscopy, Division of Gastroenterology, Virginia Commonwealth University, for reviewing earlier drafts of the manuscript and
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DISCLOSURE: The authors disclosed no financial relationships relevant to this publication. This study (Dr Chukmaitov) is supported by the Virginia Commonwealth University Massey Cancer Center pilot grant.
If you would like to chat with an author of this article, you may contact Dr Chukmaitov at [email protected].