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FACTORS ASSOCIATED WITH INTERVAL SURVEILLANCE AFTER ENDOSCOPIC RESECTION OF ADENOMA WITH HIGH GRADE DYSPLASIA: A SEER-MEDICARE ANALYSIS
Julia Frebault
*1,2, Alexander Troester
1, Sarah Mott
3, Lauren Weaver
1, Imran Hassan
4, Aasma Shaukat
5, Schelomo Marmor
1, Paolo Goffredo
11University of Minnesota Twin Cities, Minneapolis, MN; 2Hennepin County Medical Center, Minneapolis, MN; 3University of Iowa Hospitals and Clinics, Iowa City, IA; 4MercyOne, Des Moines, IA; 5NYU Langone Health, New York, NY
Background: Adenomas with high grade dysplasia (HGD) carry an increased risk of post-colonoscopy neoplasia, therefore current guidelines recommend a short-interval surveillance colonoscopy at 3 years following endoscopic polypectomy. There are known barriers to screening endoscopy in the general population, however factors influencing surveillance following removal of adenomas with HGD are poorly studied. This study aimed to identify patient characteristics associated with guideline discordant follow-up to better inform targeted quality improvement initiatives.
Study Design: Adults aged ?65 years with pathology revealing adenoma with HGD following were identified in the Surveillance, Epidemiology, and End Results-Medicare-linked database from 2006-2017. Only patients with 6 months of continuous coverage prior to and 36 months following diagnosis of adenoma with HGD were included. Those with a malignant diagnosis within 6 months after polypectomy were excluded. Cox regression assessed the effect of demographic and treatment information on the odds of surveillance completion.
Results: A total number of 475 patients (54% male, 84% white, 59% married) were identified (Table 1). Seventy percent underwent surveillance colonoscopy within 3 years of HGD polypectomy. On univariable analysis, there was no significance associated with sex, household income, or residence in metropolitan area on the odds of follow-up within three years. Race, marital status, and age were significant on univariable analysis and were included in the multivariable model. In multivariable analysis, non-white (OR 0.55, 95% CI 0.32-0.94) and unmarried (OR 0.63, 95% CI 0.41-0.97) patients were at decreased odds of undergoing a surveillance colonoscopy within 3 years of polyp diagnosis. Similarly, increasing age was associated with lower odds of completing surveillance colonoscopy within three years (OR 0.95, 95% CI 0.92-0.99; Table 2).
Conclusions:In this US population-based cohort of patients, the adherence to recommended repeat surveillance following the diagnosis of an adenoma with HGD was 70%. Older, unmarried, and non-white patients were more likely to miss appropriate interval screening, suggesting a quality improvement opportunity among Medicare beneficiaries.
Table 1. Demographic and polyp characteristics of patients with adenoma with high grade dysplasia diagnosed between 2006-2017.
Table 2. Multivariable analysis of factors associated with the odds of follow-up surveillance colonoscopy within three years of diagnosis of adenoma with high grade dysplasia.
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