Many Colonoscopies For Seniors May Be Inappropriate

Editor's Choice
Main Category: Colorectal Cancer
Also Included In: GastroIntestinal / Gastroenterology;  Seniors / Aging;  Medicare / Medicaid / SCHIP
Article Date: 12 Mar 2013 - 1:00 PDT


A considerable percentage of colonoscopies that are performed on seniors could be potentially inappropriate, researchers from the University of Texas Medical Branch, Galveston, reported in JAMA Internal Medicine.

Kristin M. Sheffield, Ph.D., and team set out to determine how frequently potentially inappropriate colonoscopies are performed on elderly Medicare beneficiaries in Texas. They also aimed to examine variations among doctors and across geographic regions.

The researchers gathered and examined data from Medicare claims in Texas, as well as a sample from the rest of the USA.

Many colonoscopies found to be potentially inappropriate

The authors suggest that 23.4% of all colonoscopies performed in Texas and across the USA on seniors aged 70+ years, all of them Medicare beneficiaries in 2008-2009, were potentially inappropriate, according to screening recommendations or the results of a previous screening.

Below is a list of patient age and the percentage of potentially inappropriate colonoscopies:

• 70 to 75 - 9.9%
• 76 to 85 - 38.8%
• 86 years or older - 24.9%

There was a wide variation in the percentages of potentially inappropriate colonoscopies across the 796 colonoscopists the researchers looked at. After taking into account variables such as patient ethnicity, sex, race, education level and a number of comorbid conditions, the authors found that:

• 73 colonoscopists had percentages ranging from 28.7% to 45.5% (above the mean of 23.9%)
• 119 colonoscopists had percentages ranging from 6.7% to 18.6% (below the mean of 23.9%)
• The colonoscopists who were surgeons, graduates of US medical schools, and medical school graduates before 1990 tended to have percentages considerably above the mean

There is increasing evidence of colonoscopy screening overuse. A significant number of Medicare patients with negative findings may be undergoing a second screening too early.

Colonoscopies for this age groups costs Medicare approximately $500 million annually; patients are subsequently put at an increased risk of bleeding and other side effects, the investigators found.

Dr. Sheffield and team concluded:

"Inappropriate use of colonoscopy involves unnecessary risk for older patients and consumes resources that could be used more effectively.

The likelihood of undergoing potentially inappropriate colonoscopy depends in part on where patients live and what physician they see."

In a separate study, researchers from the Perelman School of Medicine at the University of Pennsylvania reported in Annals of Internal Medicine (March 2013 issue) that colonoscopy screening reduces the risk of developing advanced colorectal cancer by approximately 70% in average-risk adults.

In a report published in Annals of Internal Medicine (December 2012 issue), the authors found that colonoscopy guidelines from the United Kingdom might be better at identifying patients who need short-interval follow-up screening, compared to guidelines from the USA.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

• Additional
• References
• Citations