title: Overutilization of post-polypectomy surveillance colonoscopy in clinical practice: a prospective, multicentre study.
abstract: BACKGROUND
  Although the adherence to post-polipectomy recommendations is advocated as a quality indicator of colonoscopy programmes, prospective data on actual use of surveillance are lacking.
  
  
  OBJECTIVE
  To evaluate the appropriateness of post-polypectomy surveillance colonoscopy on a community-wide basis and to identify factors associated with it.
  
  
  METHODS
  Data on consecutive post-polypectomy surveillance examinations performed over a 4-week period in 29 Italian endoscopy units were collected. The time interval between index and surveillance colonoscopy was calculated and compared to guidelines recommendations. Determinants of surveillance timing appropriateness were assessed by logistic step-wise regression.
  
  
  RESULTS
  Of 7081 consecutive outpatients, 1218 (17.2%) were referred for post-polypectomy surveillance and 902 were included into the analysis. Surveillance colonoscopy was prescribed correctly in 330 subjects (36.6%) and earlier than recommended by guidelines in 490 (54.3%). Low-risk subjects had an anticipated surveillance colonoscopy more frequently than global cohort (67.4% vs. 54.3%, p<0.001). At multivariate analysis, determinants of correct surveillance timing were high-volume workload centres (OR 1.92; 1.41-2.63 95%CI), centres providing written recommendation on surveillance interval (OR 1.70; 1.18-2.58 95%CI) and surveillance examinations performed within the national screening programme (OR 2.62; 1.92-3.59 95%CI).
  
  
  CONCLUSIONS
  In community practice, post-polipectomy surveillance colonoscopy is often performed earlier than recommended, especially in low-risk subjects. Interventions to improve adherence to guidelines and to reduce unnecessary examinations are needed.
authors.affiliation: Gastroenterology Unit, Valduce Hospital, Como, Italy. francoradaelli@virgilio.it
authors.forename: Franco
authors.initials: F
authors.lastname: Radaelli
authors.forename: Silvia
authors.initials: S
authors.lastname: Paggi
authors.forename: Aurora
authors.initials: A
authors.lastname: Bortoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Pretis
mesh_terms: D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D016015:Logistic Models; D015999:Multivariate Analysis; D009313:National Health Programs / Q000706:statistics & numerical data; D016017:Odds Ratio; D010347:Patient Care Planning / Q000706:statistics & numerical data; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013997:Time Factors; D016526:Workload / Q000706:statistics & numerical data