Comparison of procedural outcomes between morning and afternoon colonoscopies performed by colorectal surgeons

BACKGROUND AND OBJECTIVE

Colonoscopy is a common procedure performed by colorectal surgeons for screening, diagnosis, and surveillance of various colorectal diseases. Existing literature has conflicting data on quality outcomes of colonoscopies performed in the afternoon and the morning schedules and only includes colonoscopies performed by gastroenterologists. We sought to analyze procedural outcomes between morning and afternoon colonoscopies performed by colorectal surgeons.

DATA SOURCES AND MAIN OUTCOME MEASURES

A retrospective chart review of colonoscopies performed by colorectal surgeons at a tertiary care center from October 2018 through July 2020 was performed. Complete colonoscopies with documented times were included. Patients with colonic resection and incomplete colonoscopy were excluded. Main outcome measures adenoma and polyp detection rates and colonoscopy time variables were compared between morning and afternoon colonoscopies.

RESULTS

A total of 781 patients were analyzed. Colonoscopies were evenly distributed during shifts (49% morning and 51% afternoon). The overall polyp and adenoma detection rates were 46% and 29%, respectively. There were no significant differences in adenoma and polyp detection rates and colonoscopy duration between morning and afternoon colonoscopies. Multivariate analysis demonstrated that history of prior polypectomy was an independent predictor of adenoma detection rate (OR: 2.17, 95% CI 1.33-3.54, p = 0.002) and was associated with significantly increased colonoscopy times in afternoon shift.

CONCLUSION

There were no differences in quality outcomes of adenoma and polyp detection rates between morning and afternoon colonoscopies performed by colorectal surgeons. In addition to known predictors, cecal intubation time and history of polypectomy were also independent predictors of adenoma detection rate. Patients with prior polypectomy had increased colonoscopy times in afternoon shift. Since colorectal surgeons perform higher proportion of diagnostic and surveillance colonoscopies, these patients may be better suited for colonoscopies in morning shift.

Variation in abdominal wall closure techniques in lower transverse incisions: a nationwide survey across specialties

PURPOSE

Lower transverse abdominal incisions are typically used by obstetricians/gynecologists and colorectal surgeons. The suture technique and choice of material when closing the abdomen is an essential factor to decrease the risk of incisional hernia. We conducted a nationwide survey among obstetricians/gynecologists and colorectal surgeons investigating the surgical handling of the fascia, rectus muscle, subcutis, peritoneum, and skin, in lower transverse incisions.

METHODS

All departments of obstetrics/gynecology and departments of surgery performing colorectal surgery in Denmark were invited to participate. An online questionnaire was sent to consultant obstetricians/gynecologists and colorectal surgeons. The survey consisted of demographic information together with questions on surgical details. The study was reported according to STROBE guidelines.

RESULTS

A total of 252 (64.5%) consultants provided a complete response to the survey. We found that 98.0% of the colorectal surgeons and 65.8% of the obstetricians/gynecologists used monofilament suture when closing the fascia. The majority of the colorectal surgeons used continuous suture and small bites technique. This was only the case for half of the obstetricians/gynecologists. Approximately two thirds of the colorectal surgeons and one third of the OB/GYN used the suture length to wound length ratio > 4:1. Furthermore, we found significant differences between the groups in the handling of subcutis, peritoneum, and skin.

CONCLUSION

We found significant variation in abdominal wall closure techniques in lower transverse incisions. Disagreement between the current guidelines within the specialties together with insufficient evidence on the closure of lower transverse incisions emphasizes the need for education as well as further studies.

Exploring clinicians' attitudes about using aspirin for risk reduction in people with Lynch Syndrome with no personal diagnosis of colorectal cancer

Recent research has shown that aspirin reduces the risk of cancers associated with Lynch Syndrome. However, uncertainty exists around the optimal dosage, treatment duration and whether the benefits of aspirin as a risk-reducing medication (RRM) outweigh adverse medication related side-effects. Little is known about clinicians' attitudes, current practice, and perceived barriers to recommending aspirin as a RRM. To explore the attitudes of clinicians who discuss risk management options with patients with Lynch Syndrome towards using aspirin as a RRM. Clinicians were invited through professional organisations to complete an online survey. Topics included their clinical experience with Lynch Syndrome, views and practice of recommending aspirin as a RRM, and knowledge about clinical risk management guidelines for Lynch Syndrome. Comparison of attitudes was made between three professional groups. 181 respondents were included in the analysis: 59 genetics professionals (genetic counsellors and clinical geneticists, medical oncologists with specialist training in familial cancer), 49 gastroenterologists and 73 colorectal surgeons. Most clinicians (76 %) considered aspirin to be an effective RRM and most (72 %) were confident about discussing it. In all professional categories, those who were confident about discussing aspirin with patients perceived it to be an effective RRM (OR = 2.8 [95 % CI = 1.8-4.2], p < 0.001). Eighty percent (47/59) of genetics professionals reported having discussed the use of aspirin with Lynch Syndrome patients compared to 69 % of gastroenterologists and 68 % of colorectal surgeons. Those who considered aspirin as an effective RRM or who felt confident in their knowledge of the aspirin literature were more likely (OR = 10 [95 % CI = 1.5-65], p = 0.010, OR = 6 [95 % CI = 2.2-16], p < 0.001, respectively) to discuss it with their patients than other professionals in the study. Similarly health professionals who felt confident in their knowledge of literature of aspirin/confident in discussing with the patients were more likely (OR = 6 [95 % CI = 2.2-16], p < 0.001) to discuss with their patients. Health professionals who saw more than ten patients with Lynch Syndrome per year were more likely to be confident in their knowledge of the aspirin literature and discussing it with patients (OR = 4.1 [95 % CI = 1.6-10.2], p = 0.003). Explicit recommendations to take aspirin, was reported by 65/83 (78 %) of health professionals. Eighty-seven percent of health professionals reported a need for patient educational materials about aspirin. Continuing training is needed to increase clinicians' confidence in their knowledge of the literature on the use of aspirin as a RRM. Patient education materials may be helpful in improving consistency in patient care and facilitate communication between clinicians and people living with Lynch Syndrome.