Comparative Analysis of Outpatient and Inpatient Bowel Preparation for Colonoscopy: Evaluating Quality Outcomes and Identifying Contributing Factors
Abstract
Objective: Effective bowel preparation is crucial for a successful colonoscopy. Comparative analyses between inpatient and outpatient bowel preparations are limited and inconsistent. This study aimed to compare the outcomes of outpatient and inpatient bowel preparations and identify the factors contributing to suboptimal results.
Material and Methods: A retrospective analysis of colonoscopy reports from a single surgeon at a provincial hospital in Thailand was conducted. Data were collected from patients aged 18 or older who underwent colonoscopies between July 2021 and June 2023. The parameters analyzed included demographic information, underlying diseases, bowel preparation methods, medications, and quality indicators. The Boston Bowel Preparation Scale (BBPS) was used to assess preparation quality.
Results: Among the 222 patients included, 180 (81.1%) had outpatient and 42 (18.9%) had inpatient bowel preparation. Significant differences were found between the groups in age, BMI, underlying diseases, hemoglobin levels, symptoms, indications for colonoscopy, and choice of bowel preparation medication. Propensity score matching balanced baseline characteristics. In the matched cohort, the outpatient group had a higher rate of satisfactory bowel preparation (92.9%) compared to the inpatient group (78.6%), but this difference was not statistically significant (p-value=0.061). Within the inpatient subgroup, admission to a private room and choice of bowel preparation medication were linked to higher inadequate preparation likelihood.
Conclusion: This study found no significant differences between inpatient and outpatient bowel preparation. However, there was a trend suggesting better quality with outpatient bowel preparation. Thus, focusing on improving nursing interventions and selecting appropriate medications for inpatient bowel preparation may be beneficial.
Keywords
Full Text:
PDFReferences
Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin 2023;73:233-54. doi: 10.3322/caac.21772.
Ranganath R, Al-maamari LSS, Al Saidi AAR, Al Dujaili AHB, Mahmood MA-F. Knowledge and awareness of colorectal cancer among university students in Oman. J Health Sci Med Res 2022;40:215-22.
Kluge MA, Williams JL, Wu CK, et al. Inadequate Boston Bowel Preparation Scale scores predict the risk of missed neoplasia on the next colonoscopy. Gastrointest Endosc 2018;87:744-51. doi: 10.1016/j.gie.2017.06.012.
Jang JY, Chun HJ. Bowel preparations as quality indicators for colonoscopy. World J Gastroenterol 2014;20:2746-50. doi: 10.3748/wjg.v20.i11.2746.
May FP, Shaukat A. State of the science on quality indicators for colonoscopy and how to achieve them. Am J Gastroenterol 2020;115:1183-1190. doi: 10.14309/ajg.0000000000000622.
Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol 2021;116:458-79. doi: 10.14309/ajg.0000000000001122.
Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc 2003;58:76-9. doi: 10.1067/mge.2003.294.
Froehlich F, Wietlisbach V, Gonvers JJ, Burnand B, Vader JP. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the european panel of appropriateness of gastrointestinal endoscopy european multicenter study. Gastrointest Endosc 2005;61:378-84. doi: 10.1016/s0016-5107(04)02776-2.
Hendry PO, Jenkins JT, Diament RH. The impact of poor bowel preparation on colonoscopy: a prospective single centre study of 10,571 colonoscopies. Colorectal Dis 2007;9:745-8. doi: 10.1111/j.1463-1318.2007.01220.x.
Gao H, Liu C, Yuan X, Lu H, Xia Y, Zhang Z, et al. Face-to-face instruction and personalized regimens improve the quality of inpatient bowel preparation for colonoscopy. Dig Dis Sci 2022;67:3592-600. doi: 10.1007/s10620-021-07290-x.
Rosenfeld G, Krygier D, Enns RA, Singham J, Wiesinger H, Bressler B. The impact of patient education on the quality of inpatient bowel preparation for colonoscopy. Can J Gastroenterol 2010;24:543-6. doi: 10.1155/2010/718628.
Guo B, Zuo X, Li Z, et al. Improving the quality of bowel preparation through an app for inpatients undergoing colonoscopy: a randomized controlled trial. J Adv Nurs 2020;76:1037-45. doi: 10.1111/jan.14295.
Strauss AT, Yeh J, Martinez DA, Yenokyan G, Yoder J, Nehra R, et al. A patient-centered framework for health systems engineering in gastroenterology: improving inpatient colonoscopy bowel preparation. BMC Gastroenterol 2021;21:89. doi: 10.1186/s12876-021-01661-4.
Guardiola-Arévalo A, Granja Navacerrada A, García-Alonso FJ, Bernal Checa P, Piqué Becerra R, Guerra I, et al. Randomized clinical trial evaluating the effect of a visual educational leaflet on the preparation of colonoscopies in hospitalized patients. Rev Esp Enferm Dig 2019;111:946-52. doi: 10.17235/reed.2019.6317/2019.
Almadi MA, Alharbi O, Azzam N, Altayeb M, Thaniah S, Aljebreen A. Bowel preparation quality between hospitalized patients and outpatient colonoscopies. Saudi J Gastroenterol 2018;24:93-9. doi:10.4103/sjg.SJG_485_17.
Anderson E, Baker JD. Bowel preparation effectiveness: inpatients and outpatients. Gastroenterol Nurs 2007;30:400-4. doi: 10.1097/01.SGA.0000305220.78403.a0.
Mathew G, Agha R, Albrecht J, Goel P, Mukherjee I, Pai P, et al. STROCSS Group. STROCSS 2021: strengthening the reporting of cohort, cross-sectional and case-control studies in surgery. Int J Surg 2021;96:106165. doi: 10.1016/j.ijsu.2021.106165.
Lai EJ, Calderwood AH, Doros G, Fix OK, Jacobson BC. The boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009;69:620-5. doi: 10.1016/j.gie.2008.05.057.
Calderwood AH, Jacobson BC. Comprehensive validation of the boston bowel preparation scale. Gastrointest Endosc 2010;72:686-92. doi: 10.1016/j.gie.2010.06.068.
Calderwood AH, Schroy PC, 3rd, Lieberman DA, Logan JR, Zurfluh M, Jacobson BC. Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness. Gastrointest Endosc 2014;80:269-76. doi: 10.1016/j.gie.2014.01.031.
Clark BT, Protiva P, Nagar A, Imaeda A, Ciarleglio MM, Deng Y, et al. Quantification of adequate bowel preparation for screening or surveillance colonoscopy in men. Gastroenterology 2016;150:396-405; quiz e14-5. doi: 10.1053/j.gastro.2015.09.041.
Adler DG, Bakis G, Coyle WJ, DeGregorio B, Dua KS, Lee LS, et al. Principles of training in GI endoscopy. Gastrointest Endosc 2012;75:231-5. doi: 10.1016/j.gie.2011.09.008.
Spier BJ, Benson M, Pfau PR, Nelligan G, Lucey MR, Gaumnitz EA. Colonoscopy training in gastroenterology fellowships: determining competence. Gastrointest Endosc 2010;71:319-24. doi: 10.1016/j.gie.2009.05.012.
Zhan Q, Xiang L, Zhao X, An S, Zhou Y, Xu Y, et al. Determination of withdrawal times in individualized opportunistic screening colonoscopies. Medicine (Baltimore) 2019;98:e16819. doi: 10.1097/MD.0000000000016819.
Kössi J, Kontula I, Laato M. Sodium phosphate is superior to polyethylene glycol in bowel cleansing and shortens the time it takes to visualize colon mucosa. Scand J Gastroenterol 2003;38:1187-90. doi: 10.1080/00365520310006180.
Krygier D, Enns R. The inpatient colonoscopy: a worthwhile endeavour. Can J Gastroenterol 2008;22:977-9. doi: 10.1155/2008/576987.
Tetzlaff JE. Practical considerations in the management of sedation for colonoscopy. Curr Opin Anaesthesiol 2016;29:512-8. doi: 10.1097/aco.0000000000000352.
Frazzoni L, Radaelli F, Spada C, Mussetto A, Frazzoni M, Laterza L, et al. The diagnostic yield of colonoscopy in hospitalized patients. an observational multicenter prospective study. Dig Liver Dis 2021;53:224-30. doi: 10.1016/j.dld.2020.10.029.
Bitoun A, Ponchon T, Barthet M, Coffin B, Dugué C, Halphen M. Results of a prospective randomised multicentre controlled trial comparing a new 2-L ascorbic acid plus polyethylene glycol and electrolyte solution vs. sodium phosphate solution in patients undergoing elective colonoscopy. Aliment Pharmacol Ther 2006;24:1631-42. doi: 10.1111/j.1365-2036.2006.03167.x
Juluri R, Eckert G, Imperiale TF. Polyethylene glycol vs. sodium phosphate for bowel preparation: a treatment arm meta-analysis of randomized controlled trials. BMC Gastroenterol 2011;11:38. doi: 10.1186/1471-230x-11-38.
Jung YS, Lee CK, Kim HJ, Eun CS, Han DS, Park DI. Randomized controlled trial of sodium phosphate tablets vs polyethylene glycol solution for colonoscopy bowel cleansing. World J Gastroenterol 2014;20:15845-51. doi: 10.3748/wjg.v20.i42.15845.
Hung SY, Chen HC, Ke TW, Chen JH, Hsiao KH, Wang HM, et al. Noninferiority clinical trial comparing the bowel cleansing efficacy of sodium phosphate tablets (Quiklean®) with a polyethylene glycol/bisacodyl kit. World J Gastroenterol 2021;27:428-41. doi: 10.3748/wjg.v27.i5.428.33.
van Grootel J, Bor P, Netjes J, Veenhof C, Valkenet K. Improving physical activity in hospitalized patients: The preliminary effectiveness of a goal-directed movement intervention. Clin Rehabil 2023;37:1501-9.
Nunan D, Cai T, Gardener AD, Ordóñez-Mena JM, Roberts NW, Thomas ET, et al. Physical activity for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2022;6:CD011497. doi: 10.1002/14651858.CD011497.pub2.
Rocha RSP, Ribeiro IB, de Moura DTH, Bernardo WM, Minata MK, Morita FHA, et al. Sodium picosulphate or polyethylene glycol before elective colonoscopy in outpatients? A systematic review and meta-analysis. World J Gastrointest Endosc 2018;10:422-41. doi: 10.4253/wjge.v10.i12.422.
Amarneh BH. Social support behaviors and work stressors among nurses: a comparative study between teaching and non-teaching hospitals. Behavioral Sciences 2017;7:5.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.