Background: IBP is very common and associated with increased length of stay and cost of care. Many nonmodifiable risk factors have been identified such as socioeconomic status, male gender, and increased age, but no studies have been done to look at modifiable risk factors such as medication use, timing of colonoscopy, and diet before colonoscopy. Furthermore, no studies have been done to assess the effects of these modifiable factors on IBP.
Dr. Jeremiah Newsom
Study design: Retrospective cohort study using multivariate logistic regression analysis.
Setting: Cleveland Clinic Hospitals in Ohio and Florida.
Synopsis: Records of 8,819 patients (aged greater than 18 years) undergoing colonoscopy at Cleveland Clinic between January 2011 and June 2017 were reviewed. They found that 51% had IBP. Modifiable risk factors, including opiate use within 3 days of colonoscopy, colonoscopy performed before noon, and solid diet the day before colonoscopy, were associated with IBP. After adjustment for these variables, they found the rates of IBP were reduced by 5.6%. They also found that patients who had IBP had increased length of stay by 1 day (6 days vs. 5 days; P less than .001). This translates into 494 unnecessary hospital days or approximately $1 million dollars in unnecessary costs based on the number of patients (almost 9,000).
This study was performed in a single institution so it may be difficult to extrapolate to other institutions. Further studies need to be performed using multicenter institutions to assess accuracy of data.
Bottom line: Liquid diet or nothing by mouth (NPO) 1 day prior to colonoscopy, performing colonoscopy before noon, and avoiding opioids 3 days prior to colonoscopy are modifiable risk factors that may decrease the rate of inadequate bowel preparations in hospitalized patients.
Citation: Garber A et al. Modifiable factors associated with quality of bowel preparation among hospitalized patients undergoing colonoscopy. J Hosp Med. 2019;5:278-83.
Dr. Newsom is a hospitalist at Ochsner Health System, New Orleans.