title: Adenoma detection rates decline with increasing procedural hours in an endoscopist's workload.
abstract: BACKGROUND
  Operator fatigue may negatively influence adenoma detection (AD) during screening colonoscopy.
  
  
  OBJECTIVE
  To better characterize factors affecting AD, including the number of hours worked, and the number and type of procedures performed before an index screening colonoscopy.
  
  
  METHODS
  A retrospective cohort study was conducted involving individuals undergoing a screening colonoscopy at a major tertiary care hospital in Montreal, Quebec. Individuals were identified using an endoscopic reporting database; AD was identified by an electronic chart review. A hierarchical logistic regression analysis was performed to determine the association between patient- and endoscopist-related variables and AD.
  
  
  RESULTS
  A total of 430 consecutive colonoscopies performed by 10 gastroenterologists and two surgeons were included. Patient mean (± SD) age was 63.4±10.9 years, 56.3% were males, 27.7% had undergone a previous colonoscopy and the cecal intubation rate was 95.7%. The overall AD rate was 25.7%. Age was associated with AD (OR 1.06 [95% CI 1.03 to 1.08]), while female sex (OR 0.44 [95% CI 0.25 to 0.75]), an indication for average-risk screening (OR 0.47 [95% CI 0.27 to 0.80]) and an increase in the number of hours during which endoscopies were performed before the index colonoscopy (OR 0.87 [95% CI 0.76 to 0.99]) were associated with lower AD rates. On exploratory univariable analysis, a threshold of 3 h of endoscopy time performed before the index colonoscopy was associated with decreased AD.
  
  
  CONCLUSIONS
  The number of hours devoted to endoscopies before the index colonoscopy was inversely associated with AD rate, with decreased performance possibly as early as within 3 h. This metric should be confirmed in future studies and considered when optimizing scheduling practices.
authors.forename: Majid A
authors.initials: MA
authors.lastname: Almadi
authors.forename: Maida
authors.initials: M
authors.lastname: Sewitch
authors.forename: Alan N
authors.initials: AN
authors.lastname: Barkun
authors.forename: Myriam
authors.initials: M
authors.lastname: Martel
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005221:Fatigue; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D011792:Quebec; D012189:Retrospective Studies; D013997:Time Factors; D000066477:Work Performance / Q000706:statistics & numerical data*; D014940:Work Schedule Tolerance; D016526:Workload / Q000706:statistics & numerical data*