title: Predictors of Inadequate Inpatient Colonoscopy Preparation and Its Association with Hospital Length of Stay and Costs.
abstract: OBJECTIVE
  Adequate bowel preparation is essential to safe and effective inpatient colonoscopy. Predictors of poor inpatient colonoscopy preparation and the economic impacts of inadequate inpatient preparations are not defined. The aims of this study were to (1) determine risk factors for inadequate inpatient bowel preparations, and (2) examine the association between inadequate inpatient bowel preparation and hospital length of stay (LOS) and costs.
  
  
  METHODS
  We performed a retrospective cohort study of adult patients undergoing inpatient colonoscopy preparation over 12 months (1/1/2013-12/31/2013).
  
  
  RESULTS
  Of 524 identified patients, 22.3% had an inadequate preparation. A multiple logistic regression model identified the following potential predictors of inadequate bowel preparation: lower income (OR 1.11; 95% CI 1.04, 1.22), opiate or tricyclic antidepressant (TCA) use (OR 1.55; 0.98, 2.46), and afternoon colonoscopy (OR 1.66; 1.07, 2.59); as well as American Society of Anesthesiologists (ASA) class ≥3 (OR 1.15; 1.05, 1.25) and symptoms of nausea/vomiting (OR 1.14; 1.04, 1.25) when a fair preparation was considered inadequate. Inadequate bowel preparation was associated with significantly increased hospital LOS (model relative mean estimate 1.25; 95% CI 1.03, 1.51) and hospital costs (estimate 1.31; 1.03, 1.67) when compared to adequate preparations.
  
  
  CONCLUSIONS
  The rate of inadequate inpatient bowel preparations is high and associated with a significant increase in hospital LOS and costs. We identified five potential predictors of inadequate inpatient preparation: lower socioeconomic class, opiate/TCA use, afternoon colonoscopies, ASA class ≥3, and pre-preparation nausea/vomiting; these data should guide future initiatives to improve the quality of inpatient bowel preparations.
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair St. Suite 1400, Chicago, IL, 60611, USA. rena.yadlapati@northwestern.edu.
authors.forename: Rena
authors.initials: R
authors.lastname: Yadlapati
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair St. Suite 1400, Chicago, IL, 60611, USA.
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Johnston
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair St. Suite 1400, Chicago, IL, 60611, USA.
authors.forename: Dyanna L
authors.initials: DL
authors.lastname: Gregory
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair St. Suite 1400, Chicago, IL, 60611, USA.
authors.forename: Jody D
authors.initials: JD
authors.lastname: Ciolino
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair St. Suite 1400, Chicago, IL, 60611, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cooper
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair St. Suite 1400, Chicago, IL, 60611, USA.
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001071:Appointments and Schedules; D002400:Cathartics / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D003113:Colonoscopy / Q000009:adverse effects / Q000191:economics* / Q000592:standards; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009325:Nausea / Q000209:etiology; D016017:Odds Ratio; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000191:economics* / Q000592:standards; D013997:Time Factors; D014839:Vomiting / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid; D000929:Antidepressive Agents, Tricyclic; D002400:Cathartics
keywords: Bowel preparation; Inpatient colonoscopy; Quality