HALT: Do Hot, Late or Tiring Conditions Affect Quality Measures in Colonoscopy?
J R Campion, E Slattery
Department of Gastroenterology, University Hospital Galway
It has been postulated that polyp detection rate (PDR) and adenomas per positive procedure (APP)/polyps per positive procedure (PPP) vary according to time of day, with lower There is disagreement in the literature on the presence and magnitude of such variation. Separately, thermal stress is recognised as a potential cause of decreased productivity and increased fatigue, which may theoretically lead to increased polyp miss rate. Infection control measures during the initial phase of the COVID pandemic necessitated wearing extra personal protective equipment (PPE) during endoscopic procedures. Such PPE may further increase thermal stress and fatigue.
1. To determine whether the quality measures of withdrawal time, PDR and PPP are affected by a. time of day b. morning versus afternoon list c. outdoor temperature 2. To determine whether withdrawal time, PDR and PPP on days with high outdoor temperature varied between pre-COVID and the initial wave of COVID.
A retrospective study was performed using data on withdrawal time, polyp detection and polypectomy, extracted from the hospital’s electronic endoscopy reporting system. Data on daily maximum temperature were obtained from Met Éireann. Descriptive statistics and non-parametric tests of correlation were performed using SPSS 27.
Data were analysed from a total of 29,941 colonoscopies carried out at UHG between April 2013 and September 2019. The median withdrawal time for procedures where no polyp was detected was 8 minutes, with no difference observed according to time of day, morning versus afternoon list or outdoor temperature. There was a significant difference in PDR between morning and afternoon lists 38.6% vs 26.1% (p<0.001) but no significant difference between days with low/medium outdoor temperature and days with high outdoor temperature. A Mann-Whitney U Test showed PPP was higher in morning procedures (median 2) compared to afternoon procedures (median = 1) U = 8,996,429, p =0.014. There was no difference observed in withdrawal time, PDR or PPP during hot outdoor temperatures as compared to cool/medium outdoor temperatures during the initial phase of the COVID-19 pandemic.
Differences observed between PDR and PPP in morning and afternoon endoscopy lists may be partially explained by scheduling of national cancer screening colonoscopies preferentially on morning lists. Despite use of heavier PPE, quality measures were not compromised during hot weather in the COVID pandemic, in an endoscopy unit without air conditioning.