RESUMEN
Background Colorectal cancer is one of the most common internal malignancies affecting Australians, and colonoscopy is widely accepted as a part of comprehensive large bowel assessment. Different specialties perform colonoscopies, most commonly general surgeons and gastroenterologists. Analysing performance outcomes against benchmarks allows insight into inter-specialty differences and enables the improvement of overall service provision and quality. Methods We performed a retrospective single-centre cohort study on 2086 patients undergoing colonoscopies by seven surgeons (S) and nine gastroenterologists (G) between July 2021 and June 2023. Primary outcomes were comparative caecal intubation rates (CIR), photo documentation rates (PDR), documented withdrawal rates (DWR), withdrawal times (WT), and adenoma detection rates (ADR). Secondary outcomes characterised adenoma frequency, optimal WT, and indications for colonoscopies. Results We found significant differences in CIR (S: 94.9%, 990/1043; G: 99%, 1033/1043, P<0.01), PDR (S: 95.9%, 949/990; G: 99.1%, 1024/1033, P<0.01), DWR (S: 17.4%, 181/1043; G: 87.3%, 911/1043, P<0.01), WT >6 minutes (S: 82.3%, 149/181; G: 97.8%, 891/911, P<0.01), and ADR (S: 37.9%, 193/509; G: 59.7%, 421/705, P<0.01). Subgroup analysis revealed adenoma frequency peaked at 50-70 years old and optimal WT was ≥9 minutes. We demonstrated surgeons mainly perform colonoscopies for diverticulitis surveillance, abnormal imaging, post-cancer resections, and rectal bleeding, but gastroenterologists predominantly investigate bowel symptoms, polyp surveillance, positive faecal occult blood test, and anaemia. Conclusion Despite both specialties surpassing national standards in CIR and ADR, there were significant differences in performance indicators. We believe ADR differences could be explained by different indications specialties perform colonoscopies for. Increasing WT ≥9 minutes could improve ADR, and education on the usage of withdrawal timer on endoscopes will improve DWR.
RESUMEN
Objective: The aim of this study is to characterize long-term morbidities of oesophageal atresia (OA) with or without tracheoesophageal fistula (TOF). Methods: Infants born with OA/TOF from 2000 to 2016 in Western Australia were included for analysis. Infants were categorized into high-risk and low-risk groups based on the presence of one or more perioperative risk factors [low birth weight, vertebraldefects, anal atresia, cardiac defects, TOF, renalanomalies, limb abnormalities (VACTERL), anastomotic leak, long gap OA, and failure to establish oral feeds within the first month] identified by a previous Canadian study. Frequency of morbidities in infants with perioperative risk factors was compared. Results: Of 102 patients, 88 (86%) had OA with distal TOF (type C). The most common morbidities in our cohort were anastomotic oesophageal strictures (AS) (n=53, 52%), tracheomalacia (n=48, 47%), gastroesophageal reflux disease (GORD) (n=42, 41%) and recurrent respiratory tract infections (n=40, 39%). Presence of GORD (30/59 vs 12/43, p=0.04) and median frequency of AS dilatations (8 vs 3, n=59, p=0.03) were greater in the high-risk group. This study further confirmed that inability to be fed orally within the first month was associated with high morbidities. Conclusions: Gastrointestinal and respiratory morbidities remain high in OA/TOF regardless of perioperative risk factors. Inability to be fed orally within the first month is a predictor of poor outcomes with high frequency of gastrointestinal and respiratory comorbidities.