title: Annual colonoscopy volume and maintenance of competency for surgeons.
abstract: To determine whether the annual case volume of general surgeons (greater or less than 200 colonoscopies) is associated with quality outcomes.
  
  
  
  This retrospective cohort study involved all adults who underwent colonoscopy by a surgeon in the city of St. John's, NL, during the first 6 months of 2012. Subjects were identified through records from the health authority, and data were recorded on a standardized data sheet. Univariate analysis followed by stepwise multivariable logistic regression was performed to determine whether there was an association between quality outcomes (colonoscopy completion rate, adenoma detection rate) and predictors of these outcomes including annual colonoscopy volume, patient age, gender, indication for colonoscopy, and ASA score. A Chi-squared test was used to determine whether other outcomes were associated with annual colonoscopy volume.
  
  
  
  Data were collected on 1060 patients. Mean age was 59.5 (sd 12.2) years with 550 females. A total of 13 surgeons were studied, of which 7 performed less than 200 annual colonoscopies over the previous 2 years (low-volume group) and 6 performed more than 200 annual colonoscopies over the previous 2 years (high-volume group). While there was a significant difference in the colonoscopy completion rate favoring the high-volume group (82.2 vs. 91.1 %, p < 0.001), no difference was noted in the adenoma detection rate between groups (16.7 vs. 17.7 %, p = 0.762). The regression model revealed that colonoscopy completion was also associated with an indication of screening or surveillance and an ASA score of 1 or 2. The adenoma detection rate was associated with older age and male gender. There was no statistically significant association between annual colonoscopy volume and other safety outcome measures.
  
  
  
  Performing over 200 colonoscopies annually is associated with higher colonoscopy completion rates, but does not appear to be associated with other quality measures.
authors.affiliation: Department of Surgery, Memorial University, St. John's, Canada. dpace@mun.ca.|Department of Surgery, Health Sciences Center, St. John's, NL, A1B 3V6, Canada. dpace@mun.ca.
authors.forename: David
authors.initials: D
authors.lastname: Pace
authors.affiliation: Department of Medicine, Memorial University, St. John's, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Borgaonkar
authors.affiliation: Department of Surgery, Memorial University, St. John's, Canada.
authors.forename: Brad
authors.initials: B
authors.lastname: Evans
authors.affiliation: Department of Surgery, Memorial University, St. John's, Canada.
authors.forename: Curtis
authors.initials: C
authors.lastname: Marcoux
authors.affiliation: Department of Surgery, Memorial University, St. John's, Canada.
authors.forename: Muna
authors.initials: M
authors.lastname: Lougheed
authors.affiliation: Department of Surgery, Memorial University, St. John's, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Falk
authors.affiliation: Department of Surgery, Memorial University, St. John's, Canada.
authors.forename: Nikita
authors.initials: N
authors.lastname: Hickey
authors.affiliation: Department of Surgery, Memorial University, St. John's, Canada.
authors.forename: Meghan
authors.initials: M
authors.lastname: O'Leary
authors.affiliation: Department of Medicine, Memorial University, St. John's, Canada.
authors.forename: Jerry
authors.initials: J
authors.lastname: McGrath
authors.affiliation: Department of Surgery, Memorial University, St. John's, Canada.
authors.forename: Darrel
authors.initials: D
authors.lastname: Boone
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery; D000368:Aged; D002983:Clinical Competence; D003111:Colonic Polyps / Q000175:diagnosis* / Q000601:surgery; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D013502:General Surgery; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009523:Newfoundland and Labrador; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D066231:Surgeons
keywords: Colonoscopy; Quality; Volume–outcome relationship