Importance Although colonoscopy is frequently performed in the United States, there is limited evidence to support threshold values for physician adenoma detection rate as a quality metric. Objective To evaluate the association between physician adenoma detection rate values and risks of postcolonoscopy colorectal cancer and related deaths. Design, Setting, and Participants Retrospective cohort study in 3 large integrated health care systems (Kaiser Permanente Northern California, Kaiser Permanente Southern California, and Kaiser Permanente Washington) with 43 endoscopy centers, 383 eligible physicians, and 735 396 patients aged 50 to 75 years who received a colonoscopy that did not detect cancer (negative colonoscopy) between January 2011 and June 2017, with patient follow-up through December 2017. Exposures The adenoma detection rate of each patient's physician based on screening examinations in the calendar year prior to the patient's negative colonoscopy. Adenoma detection rate was defined as a continuous variable in statistical analyses and was also dichotomized as at or above vs below the median for descriptive analyses. Main Outcomes and Measures The primary outcome (postcolonoscopy colorectal cancer) was tumor registry-verified colorectal adenocarcinoma diagnosed at least 6 months after any negative colonoscopy (all indications). The secondary outcomes included death from postcolonoscopy colorectal cancer. Results Among 735 396 patients who had 852 624 negative colonoscopies, 440 352 (51.6%) were performed on female patients, median patient age was 61.4 years (IQR, 55.5-67.2 years), median follow-up per patient was 3.25 years (IQR, 1.56-5.01 years), and there were 619 postcolonoscopy colorectal cancers and 36 related deaths during more than 2.4 million person-years of follow-up. The patients of physicians with higher adenoma detection rates had significantly lower risks for postcolonoscopy colorectal cancer (hazard ratio [HR], 0.97 per 1% absolute adenoma detection rate increase [95% CI, 0.96-0.98]) and death from postcolonoscopy colorectal cancer (HR, 0.95 per 1% absolute adenoma detection rate increase [95% CI, 0.92-0.99]) across a broad range of adenoma detection rate values, with no interaction by sex (P value for interaction = .18). Compared with adenoma detection rates below the median of 28.3%, detection rates at or above the median were significantly associated with a lower risk of postcolonoscopy colorectal cancer (1.79 vs 3.10 cases per 10 000 person-years; absolute difference in 7-year risk, -12.2 per 10 000 negative colonoscopies [95% CI, -10.3 to -13.4]; HR, 0.61 [95% CI, 0.52-0.73]) and related deaths (0.05 vs 0.22 cases per 10 000 person-years; absolute difference in 7-year risk, -1.2 per 10 000 negative colonoscopies [95%, CI, -0.80 to -1.69]; HR, 0.26 [95% CI, 0.11-0.65]). Conclusions and Relevance Within 3 large community-based settings, colonoscopies by physicians with higher adenoma detection rates were significantly associated with lower risks of postcolonoscopy colorectal cancer across a broad range of adenoma detection rate values. These findings may help inform recommended targets for colonoscopy quality measures.

中文翻译：

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医生腺瘤检出率与结肠镜检查后结直肠癌的关联。

重要性 尽管结肠镜检查在美国经常进行，但支持医生腺瘤检出率阈值作为质量指标的证据有限。目的 评估医生腺瘤检出率值与结肠镜检查后结直肠癌和相关死亡风险之间的关联。设计、设置和参与者 在 3 个大型综合医疗保健系统（北加州 Kaiser Permanente、南加州 Kaiser Permanente 和华盛顿 Kaiser Permanente）中进行的回顾性队列研究，共有 43 个内窥镜中心、383 名合格医生和 735 396 名年龄在 50 至 75 岁之间的患者2011 年 1 月至 2017 年 6 月期间接受结肠镜检查未检测到癌症的患者（结肠镜检查阴性），并对患者进行随访至 2017 年 12 月。 暴露 每位患者医生的腺瘤检出率基于患者之前一年的筛查检查结肠镜检查阴性。腺瘤检出率被定义为统计分析中的连续变量，并且在描述性分析中也被分为等于或高于中位数与低于中位数。主要结果和措施 主要结果（结肠镜检查后结直肠癌）是在任何阴性结肠镜检查（所有指征）后至少 6 个月诊断出的经肿瘤登记验证的结直肠腺癌。次要结局包括结肠镜检查后结直肠癌死亡。结果 735 396例患者中，852 624例结肠镜检查阴性，其中女性患者440 352例（51.6%），患者中位年龄为61.4岁（IQR，55.5~67.2岁），每位患者中位随访时间为3.25年（IQR） ，1.56-5.01年），在超过240万人年的随访期间，有619例结肠镜检查后结直肠癌和36例相关死亡。腺瘤检出率较高的医生的患者患结肠镜检查后结直肠癌的风险显着较低（风险比 [HR]，绝对腺瘤检出率每增加 1%，风险比为 0.97 [95% CI，0.96-0.98]）和结肠镜检查后结直肠癌死亡风险显着较低（ HR，每 1% 绝对腺瘤检出率增加 0.95 [95% CI，0.92-0.99]），在广泛的腺瘤检出率值中，没有性别交互作用（交互 P 值 = 0.18）。与低于中位数 28.3% 的腺瘤检出率相比，中位数或以上的检出率与结肠镜检查后结直肠癌的较低风险显着相关（每 10000 人年 1.79 例与 3.10 例；7 年风险的绝对差异，每 10 000 例阴性结肠镜检查中 -12.2 例 [95% CI，-10.3 至 -13.4]；HR，0.61 [95% CI，0.52-0.73]）和相关死亡（每 10 000 人年 0.05 例与 0.22 例；绝对差异7 年风险，每 10 000 例阴性结肠镜检查 -1.2 [95%，CI，-0.80 至 -1.69]；HR，0.26 [95% CI，0.11-0.65]）。结论和相关性 在 3 个大型社区环境中，在广泛的腺瘤检出率值范围内，腺瘤检出率较高的医生进行的结肠镜检查与结肠镜检查后结直肠癌的较低风险显着相关。这些发现可能有助于为结肠镜检查质量措施的推荐目标提供信息。