title: Rates of Suboptimal Preparation for Colonoscopy Differ Markedly Between Providers: Impact on Adenoma Detection Rates.
abstract: OBJECTIVE
  We sought to determine if providers who have higher standards for optimal bowel preparation might be more fastidious in their examination of the colon and, therefore, have higher adenoma detection rates (ADRs).
  
  
  BACKGROUND
  ADRs are a reliable and objective marker of colonoscopy performance. Suboptimal bowel preparation impacts upon adenoma detection; however, physicians have varying standards for grading bowel preparation.
  
  
  METHODS
  Endoscopy reports of patients who underwent screening colonoscopy in 2011 at 1 academic medical center were reviewed. Bowel preparations labeled "fair," "poor," or "unsatisfactory" were considered suboptimal. The ADR was calculated for each endoscopy provider and was correlated with the provider's suboptimal preparation rate. Logistic regression was used to determine independent predictors of adenoma detection.
  
  
  RESULTS
  1649 examinations from 11 separate gastroenterologists were included. Preparation was suboptimal in 22% of examinations overall. The rate of suboptimal preparations varied widely among providers, ranging from 3% to 40%. Overall ADR was 23%, with a range of 13% to 31%. Providers' suboptimal preparation rate was not significantly correlated with ADR (r=-0.22, P=0.51). After adjusting for age and sex, adenoma detection was not associated with provider suboptimal preparation rate (P=0.28).
  
  
  CONCLUSIONS
  Rates of suboptimal preparation vary widely between providers, but were not correlated with ADR. This suggests that a high suboptimal preparation rate is not a marker of higher quality standards and expectations by the provider. The impact of physician personality traits on colonoscopy performance requires further study.
authors.affiliation: *Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons †Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: SriHari
authors.initials: S
authors.lastname: Mahadev
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
mesh_terms: D000046:Academic Medical Centers; D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D002400:Cathartics / Q000008:administration & dosage*; D003113:Colonoscopy / Q000379:methods* / Q000592:standards; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D002400:Cathartics