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Regional Variability of Repeat Esophagogastroduodenoscopy Use in the National Veteran Population

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Abstract

Background

Esophagogastroduodenoscopy (EGD) procedures are performed frequently to evaluate gastrointestinal disease and symptoms.

Aim

To determine regional practice variability of repeat EGDs in a national population.

Methods

The study sample included US Veterans with an outpatient index EGD from 1/1/2008 to 12/2010. We determined risk of repeat endoscopy from 1/2008 to 10/1/2014. A logistic regression model was used to assess the association between the odds of repeated EGD and patient demographics, ICD diagnostic codes, and geographic region. Multivariable logistic regression was performed to obtain the adjusted odds ratio and predicted probabilities of repeat EGDs by region.

Results

A total of 202,086 patients had an index endoscopy from 1/2008 to 12/2010. Unique patients with an index endoscopy were predominantly male (93.2%), white (72.8%), and on average 61 years. A total of 58,469 patients (28.9%) had one or more repeat EGDs, accounting for 103,253 repeat procedures through 10/2014. ICD-9-CM codes associated with increased risk of repeat procedures were Barrett’s esophagus (OR 3.6, 95% CI 3.5–3.7), dysphagia (OR 1.3, 95% CI 1.2–1.3), ulcer (OR 1.3, 95% CI 2.2–2.4), stricture (OR 1.8, 95% CI 1.7–1.9), and esophageal varices (OR 2.8, 95% CI 2.7–3.0). There was a significant difference in the probability of repeat EGD by VA region, with the Midwest region having the highest probability (31.2%) and Southeast the lowest probability (27.3%). This difference would account for 400 more EGD procedures per 10,000 Veterans, after adjusting for patient demographics and diagnosis codes.

Conclusions

Regional practice variability accounts for a substantial volume of repeat EGD procedures, regardless of patient characteristics and associated diagnoses.

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Funding

This work was partially supported by the Salt Lake City IDEAS 2.0 COIN which is funded by VA HSR&D Grant I50HX001240.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, 30 N 1900 E, SOM 4R118, Salt Lake City, UT, 84132, USA

    Andrew J. Gawron, Garrett Cole & John Fang

  2. Salt Lake City Specialty Care Center of Innovation, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA

    Andrew J. Gawron & Garrett Cole

  3. Salt Lake City (SLC) VA Informatics Decision Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA

    Andrew J. Gawron & Matthew Samore

  4. Huntsman Cancer Center, Salt Lake City, UT, USA

    Nan Hu

  5. Northwestern University, Chicago, IL, USA

    William K. Thompson

  6. Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Matthew Samore

Authors
  1. Andrew J. Gawron
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  2. Garrett Cole
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  3. Nan Hu
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  4. William K. Thompson
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  5. John Fang
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Corresponding author

Correspondence to Andrew J. Gawron.

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Conflict of interest

The authors have no financial conflict of interest to disclose related to this project.

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Gawron, A.J., Cole, G., Hu, N. et al. Regional Variability of Repeat Esophagogastroduodenoscopy Use in the National Veteran Population. Dig Dis Sci 62, 2303–2310 (2017). https://doi.org/10.1007/s10620-017-4678-8

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  • DOI: https://doi.org/10.1007/s10620-017-4678-8

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