Factors That Affect Adequacy of Colon Cleansing for Colonoscopy in Hospitalized Patients.,Clinical Gastroenterology and Hepatology

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Factors That Affect Adequacy of Colon Cleansing for Colonoscopy in Hospitalized Patients.
Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2020-03-18 , DOI: 10.1016/j.cgh.2020.02.055
Lorenzo Fuccio ₁ , Leonardo Frazzoni ₁ , Cristiano Spada ₂ , Alessandro Mussetto ₃ , Carlo Fabbri ₄ , Mauro Manno ₅ , Giovanni Aragona ₆ , Rocco Maurizio Zagari ₁ , Emanuele Rondonotti ₇ , Gianpiero Manes ₈ , Pietro Occhipinti ₉ , Sergio Cadoni ₁₀ , Franco Bazzoli ₁ , Cesare Hassan ₁₁ , Franco Radaelli ₇ ,

Affiliation

Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy.
Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy.
Gastroenterology Unit, S. Maria delle Croci Hospital, Ravenna, Italy.
Unit of Gastroenterology and Digestive Endoscopy, Forli-Cesena Hospital, AUSL Romagna, Forli-Cesena, Italy.
UOSD Gastroenterologia ed Endoscopia Digestiva, Azienda USL di Modena, Italy.
Department of Internal Medicine, Gastroenterology and Hepatology Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy.
Gastroenterology Unit, Valduce Hospital, Como, Italy.
Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate Milanese Hospital, Milan, Italy.
Gastroenterology and Digestive Endoscopy Unit, Ospedale Maggiore della Carità, Novara, Italy.
Digestive Endoscopy Unit, Centro Traumatologico-Ortopedico Hospital, Iglesias, Italy.
Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.

Background & Aims

Hospitalization is associated with inadequate colon cleansing before colonoscopy. We aimed to identify factors associated to inadequate colon cleansing among inpatients, and to derive and validate a model to identify inpatients with inadequate cleansing.

Methods

We performed a prospective observational study at 12 hospitals in Italy. Consecutive adult inpatients scheduled for colonoscopy for any indication were enrolled from February through May 2019 (derivation cohort, n = 1016) and from June through August 2019 (validation cohort, n = 508). Inadequate cleansing was defined as Boston bowel preparation scale scores below 2 in any colon segment. We performed multivariate logistic regression to identify factors associated with inadequate cleansing.

Results

In the combined cohorts, 1032 patients (68%) had adequate colon cleansing. Physicians’ meetings to optimize bowel preparation (odds ratio [OR], 0.42; 95% CI, 0.27–0.65), written and oral instructions to patients (OR, 0.48; 95% CI, 0.36–0.65), admission to gastroenterology unit (OR, 0.71; 95% CI, 0.51–0.98), split-dose regimens (OR, 0.27; 95% CI, 0.20–0.35), a 1-liter polyethylene glycol-based bowel purge (OR, 0.39; 95% CI, 0.23—0.65), and 75% or more intake of bowel preparation (OR, 0.09; 95% CI, 0.05–0.15) significantly reduced odds of inadequate colon cleansing. Alternatively, bedridden status (OR, 2.14; 95% CI, 1.55–2.98), constipation (OR, 2.16; 95% CI, 1.55–3.0), diabetes mellitus (OR, 1.61; 95% CI, 1.18–2.20), use of anti-psychotic drugs (OR, 3.26; 95% CI, 1.62–6.56), and 7 or more days of hospitalization (OR, 1.02; 95% CI, 1.00–1.04) increased risk of inadequate colon cleansing. We developed a model to identify patients with inadequate cleaning using data from patients in the derivation cohort and tested it in the validation cohort. Calibration values were P = .218 for the discrimination cohort and P = .232 for the validation cohort. Discrimination values were c-statistic, 0.78 (95% CI, 0.74–0.81) for the discrimination cohort and c-statistic, 0.73 (95% CI, 0.69–0.78) for the validation cohort. We developed app for use by clinicians.

Conclusions

In a prospective observational study, we identified setting-, patient- and preparation-related factors that affect colon cleansing among inpatients. We derived and validated a model to identify patients with inadequate preparation and developed an app for clinicians. ClinicalTrials.gov no: NCT03925506

中文翻译：

影响住院患者结肠镜检查结肠清洁充分性的因素。

背景与目标

住院与结肠镜检查前结肠清洁不充分有关。我们旨在确定与住院患者结肠清洁不充分相关的因素，并推导出和验证一个模型来识别清洁不充分的住院患者。

方法

我们在意大利的 12 家医院进行了一项前瞻性观察研究。从 2019 年 2 月至 2019 年 5 月（推导队列，n = 1016）和 2019 年 6 月至 8 月（验证队列，n = 508）招募了因任何适应症而计划进行结肠镜检查的连续成年住院患者。清洁不充分被定义为波士顿肠道准备量表在任何结肠段中的得分低于 2。我们进行了多变量逻辑回归来确定与清洁不足相关的因素。

结果

在合并队列中，1032 名患者 (68%) 进行了充分的结肠清洁。优化肠道准备的医生会议（比值比 [OR]，0.42；95% CI，0.27-0.65），对患者的书面和口头说明（OR，0.48；95% CI，0.36-0.65），进入胃肠病科（ OR, 0.71; 95% CI, 0.51–0.98), 分剂量方案 (OR, 0.27; 95% CI, 0.20–0.35), 1 升聚乙二醇清肠 (OR, 0.39; 95% CI, 0.23-0.65)，以及 75% 或更多的肠道准备摄入量 (OR, 0.09; 95% CI, 0.05-0.15) 显着降低结肠清洁不足的几率。或者，卧床状态（OR，2.14；95% CI，1.55-2.98），便秘（OR，2.16；95% CI，1.55-3.0），糖尿病（OR，1.61；95% CI，1.18-2.20），使用抗精神病药物 (OR, 3.26; 95% CI, 1.62–6.56) 和住院 7 天或更长时间 (OR, 1.02; 95% CI, 1.00–1. 04) 结肠清洁不足的风险增加。我们开发了一个模型，使用衍生队列中患者的数据识别清洁不充分的患者，并在验证队列中对其进行测试。校准值是P = 0.218用于鉴别队列和P = 0.232用于验证队列。区分值是 c 统计量，0.78（95% CI，0.74-0.81）对于区分队列和 c 统计量，0.73（95% CI，0.69-0.78）对于验证队列。我们开发了供临床医生使用的应用程序。