title: Sedation in screening colonoscopy: impact on quality indicators and complications.
abstract: OBJECTIVE
  Quality indicators including cecal intubation rate (CIR) and adenoma detection rate (ADR) are established. Sex differences of quality indicators are observed, but the influence of sedation has not been investigated so far. The objective of this study is to assess the impact of sedation on quality indicators, including CIR and ADR, according to sex.
  
  
  METHODS
  We analyzed data of 52,506 screening colonoscopies performed by 196 endoscopists between November 2007 and April 2011 according to the Austrian "quality management for colon cancer prevention" program.
  
  
  RESULTS
  Sedation did not affect polyp detection rate (women P=0.7972, men P=0.3711) or ADR for both sexes (women P=0.2773, men P=0.8676). ADR was not significantly influenced by sedation (P=0.1272), but by age and sex (both P<0.0001), when the executing endoscopist was considered. Although women were more often sedated than men (90.70 vs. 81.83%; P<0.0001), CIR was slightly lower in women than in men (94.69 vs. 96.58%; P<0.0001). Sedation improved the CIR in women by 2.95% (94.96 vs. 92.01%; P<0.0001), whereas in men it was just by 1.28% (96.81 vs. 95.53%; P<0.0001). Sedated women only reached the CIR of unsedated men (94.96 vs. 95.53%; P=0.1005). Accounting for the intra-observer influence of the endoscopist, the overall CIR was influenced by the interaction of sex and age (P=0.0049), but not by sedation (P=0.1435).
  
  
  CONCLUSIONS
  Sedation does not increase adenoma or polyp detection, although it leads to an increase in CIR in men and women. This effect is more pronounced in women, yet CIR of men remains higher compared with women. Quality indicators are mainly influenced by the patient's age, sex, and the endoscopists' individual performance, rather than the endoscopists' subspeciality or procedural experience.
authors.affiliation: Quality Assurance Working Group of Austrian Society for Gastroenterology and Hepatology, Vienna, Austria.
authors.forename: Christina
authors.initials: C
authors.lastname: Bannert
authors.forename: Karoline
authors.initials: K
authors.lastname: Reinhart
authors.forename: Daniela
authors.initials: D
authors.lastname: Dunkler
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
authors.forename: Friedrich
authors.initials: F
authors.lastname: Renner
authors.forename: Peter
authors.initials: P
authors.lastname: Knoflach
authors.forename: Arnulf
authors.initials: A
authors.lastname: Ferlitsch
authors.forename: Werner
authors.initials: W
authors.lastname: Weiss
authors.forename: Monika
authors.initials: M
authors.lastname: Ferlitsch
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D000367:Age Factors; D000368:Aged; D001317:Austria; D002983:Clinical Competence; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003111:Colonic Polyps / Q000175:diagnosis; D003113:Colonoscopy / Q000379:methods* / Q000592:standards*; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards*; D008875:Middle Aged; D011336:Probability; D019984:Quality Indicators, Health Care; D012737:Sex Factors