Skip to main content
SpringerLink
Log in

Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Repeat preoperative endoscopy is common for patients with colorectal neoplasms. This can result in treatment delays, patient discomfort, and risks of colonoscopy-related complications. Repeat preoperative endoscopy has been attributed to poor communication between endoscopists and surgeons. In January 2019, mandatory electronic synoptic reporting for endoscopy was implemented to include elements consistent with quality indicators proposed in national guidelines. The aim of the present study is to assess whether the repeat preoperative endoscopy rate for colorectal lesions changed following synoptic report implementation.

Methods

A retrospective review was performed of 1690 consecutive patients who underwent elective surgical resection for colorectal neoplasms from January 2007 to June 2020 at a tertiary hospital in Canada. Patients who had an index endoscopy documented via synoptic report were compared to those reported via narrative report. Primary outcomes were rates of repeat preoperative endoscopy and inclusion of colonoscopy quality indicators: photo-documentation, tattoo placement, and bowel preparation score.

Results

In total, 1429 patients who underwent elective colorectal resection for colorectal cancers or polyps between January 2007 and June 2020 were included. 115 had index endoscopies recorded via synoptic report and 1314 by narrative report. The repeat preoperative endoscopy rate after endoscopies documented by narrative report was 29.07% (95% CI 26.63–31.61) and 25.22% (95% CI 17.58–34.17%) for synoptic report. Patients whose index endoscopies where performed by a practitioner other than their operating surgeon had a re-endoscopy rate of 36.03% (95% CI 32.82–39.33%) after narrative report and 38.81% (95% CI 27.14–51.50%) for synoptic report. Rates of tattoo placement, photo-documentation, and reporting of bowel preparation quality were all significantly increased with synoptic reports (p ≤ 0.003).

Conclusions

Endoscopy synoptic reports based on current guidelines were not associated with a decrease in rates of repeat pre-operative endoscopy at a high-volume colorectal cancer centre. Future study should examine guideline deficiencies for this purpose and make necessary modifications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Armstrong D, Barkun A, Bridges R, Carter R, de Gara C, Dubé C, Enns R, Hollingworth R, MacIntosh D, Borgaonkar M, Forget S, Leontiadis G, Meddings J, Cotton P, Kuipers EJ, Valori R, on behalf of the Canadian Association of Gastroenterology Safety and Quality Indicators in Endoscopy Consensus Group (2012) Canadian Association of Gastroenterology Consensus Guidelines on Safety and quality indicators in endoscopy. Can J Gastroenterol 26:17–31

    Article  Google Scholar 

  2. Azin A, Wood T, Hirpara D, Le Souder E, Chadi SA, Jackson T, Okrainec A, Quereshy FA (2018) Diagnostic utility of staging abdominal computerized tomography and repeat endoscopy in detecting localization errors at initial endoscopy in colorectal cancer. Surg Endosc 32:3303–3310. https://doi.org/10.1007/s00464-018-6051-1

    Article  PubMed  Google Scholar 

  3. Abbasi Al T, Saleh F, Jackson TD, Okrainec A, Quereshy FA (2014) Preoperative re-endoscopy in colorectal cancer patients: an institutional experience and analysis of influencing factors. Surg Endosc 28:2808–2814

    Article  Google Scholar 

  4. Lipof T, Bartus C, Sardella W, Johnson K, Vignati P, Cohen J (2005) Preoperative colonoscopy decreases the need for laparoscopic management of colonic polyps. Dis Colon Rectum 48:1076–1080. https://doi.org/10.1007/s10350-004-0908-1

    Article  CAS  PubMed  Google Scholar 

  5. Damore LJI, Rantis PC, Vernava AMI, Longo WE (1996) Colonoscopic perforations: Etiology, diagnosis, and management. Dis Colon Rectum 39:1308–1314. https://doi.org/10.1007/BF02055129

    Article  PubMed  Google Scholar 

  6. Sharara N, Adam V, Crott R, Barkun AN (2008) The costs of colonoscopy in a Canadian hospital using a microcosting approach. Can J Gastroenterol 22:565–570. https://doi.org/10.1155/2008/854984

    Article  PubMed  PubMed Central  Google Scholar 

  7. Deal SB, D’Angelica MI, Hawkins WG, Pucci M, Ujiki M, Brunt LM, Wexner S, Alseidi AA (2018) Synoptic operative reporting for laparoscopic cholecystectomy and pancreaticoduodenectomy: a multi institutional pilot study evaluating completeness and surgeon perceptions. Am J Surg 216:935–940. https://doi.org/10.1016/j.amjsurg.2018.06.008

    Article  PubMed  PubMed Central  Google Scholar 

  8. Maniar RL, Sytnik P, Wirtzfeld DA, Hochman DJ, McKay AM, Yip B, Hebbard PC, Park J (2015) Synoptic operative reports enhance documentation of best practices for rectal cancer. J Surg Oncol 112:555–560. https://doi.org/10.1002/jso.24039

    Article  PubMed  Google Scholar 

  9. Stogryn SE, Hardy K, Mullan MJ, Park J, Andrew C, Vergis A (2017) Synoptic operative reporting: assessing the completeness, accuracy, reliability, and efficiency of synoptic reporting for Roux-en-Y gastric bypass. Surg Endosc 32:1729–1739. https://doi.org/10.1007/s00464-017-5855-8

    Article  PubMed  Google Scholar 

  10. Renshaw AA, Mena-Allauca M, Gould EW, Sirintrapun SJ (2018) Synoptic reporting: evidence-based review and future directions. JCO Clin Cancer Inform. https://doi.org/10.1200/CCI.17.00088

    Article  PubMed  PubMed Central  Google Scholar 

  11. Stogryn S, Hardy KM, Abou-Setta AM, Clouston KM, Metcalfe J, Vergis AS (2019) Advancement in the quality of operative documentation: a systematic review and meta-analysis of synoptic versus narrative operative reporting. Am J Surg 218:624–630. https://doi.org/10.1016/j.amjsurg.2019.05.003

    Article  PubMed  Google Scholar 

  12. Edhemovic I, Temple WJ, de Gara CJ, Stuart GCE (2004) The computer synoptic operative report–a leap forward in the science of surgery. Ann Surg Oncol 11:941–947. https://doi.org/10.1245/ASO.2004.12.045

    Article  PubMed  Google Scholar 

  13. Kennedy ED, Milot L, Fruitman M, Al-Sukhni E, Heine G, Schmocker S, Brown G, McLeod RS (2014) Development and implementation of a synoptic MRI report for preoperative staging of rectal cancer on a population-based level. Dis Colon Rectum 57:700–708. https://doi.org/10.1097/DCR.0000000000000123

    Article  PubMed  Google Scholar 

  14. Sluijter CE, van Lonkhuijzen LRCW, van Slooten H-J, Nagtegaal ID, Overbeek LIH (2016) The effects of implementing synoptic pathology reporting in cancer diagnosis: a systematic review. Virchows Arch 468:639–649. https://doi.org/10.1007/s00428-016-1935-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty BM, Lieb JG, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Wani S, Weinberg DS (2015) Quality indicators for colonoscopy. Off J Am Coll Gastroenterol 110:72–90. https://doi.org/10.1038/ajg.2014.385

    Article  Google Scholar 

  16. Singh H, Kaita L, Taylor G, Nugent Z, Bernstein C (2014) Practice and documentation of performance of colonoscopy in a central Canadian health region. Can J Gastroenterol Hepatol 28:185–190. https://doi.org/10.1155/2014/635932

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hershorn O, Park J, Singh H, Clouston K, Vergis A, Helewa RM (2020) Predictors and rates of prior endoscopic tattoo localization amongst individuals undergoing elective colorectal resections for benign and malignant lesions. Surg Endosc 31:1491–1497. https://doi.org/10.1007/s00464-020-08048-8

    Article  Google Scholar 

  18. Saleh F, Abbasi TA, Cleghorn M, Jimenez MC, Jackson TD, Okrainec A, Quereshy FA (2015) Preoperative endoscopy localization error rate in patients with colorectal cancer. Surg Endosc 29:2569–2575. https://doi.org/10.1007/s00464-014-3969-9

    Article  PubMed  Google Scholar 

  19. Benneyan JC, Lloyd RC, Plsek PE (2003) Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care 12:458–464

    Article  CAS  Google Scholar 

  20. Carey RG (2002) How do you know that your care is improving? Part II: using control charts to learn from your data. J Ambulatory Care Manag KW 25:78–88

    Google Scholar 

  21. Maniar RL, Hochman DJ, Wirtzfeld DA, McKay AM, Yaffe CS, Yip B, Silverman R, Park J (2014) Documentation of quality of care data for colon cancer surgery: comparison of synoptic and dictated operative reports. Ann Surg Oncol 21:3592–3597. https://doi.org/10.1245/s10434-014-3741-3

    Article  PubMed  Google Scholar 

  22. Robertson RL, Vergis A (2020) Synoptic operative reporting: documentation of quality of care data for rectal cancer surgery. Am Surg 86:184–189

    Article  Google Scholar 

  23. Park J, Pillarisetty VG, Brennan MF, Jarnagin WR, D’Angelica MI, Dematteo RP, Coit GD (2010) Electronic synoptic operative reporting: assessing the reliability and completeness of synoptic reports for pancreatic resection. J Am Coll Surg 211:308–315. https://doi.org/10.1016/j.jamcollsurg.2010.05.008

    Article  PubMed  Google Scholar 

  24. Stogryn S, Park J, Hardy K, Vergis A (2017) Development of consensus-derived quality indicators for laparoscopic Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 13:198–203. https://doi.org/10.1016/j.soard.2016.08.018

    Article  PubMed  Google Scholar 

  25. Vergis A, Stogryn SE, Mullan MJ, Hardy K (2017) Electronic synoptic reporting: assessing the completeness of synoptic and narrative reports for Roux-en-Y gastric bypass. Surg Obes Relat Dis 13:1863–1868. https://doi.org/10.1016/j.soard.2017.02.027

    Article  PubMed  Google Scholar 

  26. Vergis A, Hardy K, Stogryn S (2019) Fellow and attending surgeon operative notes are deficient in reporting established quality indicators for Roux-en-y gastric bypass: a preliminary retrospective analysis of operative dictation. Cureus 11:e4535. https://doi.org/10.7759/cureus.4535

    Article  PubMed  PubMed Central  Google Scholar 

  27. American College of Surgeons Commission on Cancer. National accreditation program for rectal cancer (2020) Optimal Resources for Rectal Cancer Care

  28. Choi WJ, Cleghorn MC, Quereshy FA (2016) Preoperative repeat endoscopy for colorectal cancer: what is its role and when is it necessary? CJS 59:427–428. https://doi.org/10.1503/cjs.005116

    Article  Google Scholar 

  29. Azin A, Jimenez MC, Cleghorn MC, Jackson T, Okrainec A, Rossos PG, Quereshy FA (2015) sa1633 discrepancy between gastroenterologists“ and general surgeons” perspectives on repeat endoscopy in colorectal cancer. Gastrointest Endosc 81:AB290. https://doi.org/10.1016/j.gie.2015.03.407

    Article  Google Scholar 

  30. Zafar A, Mustafa M, Chapman M (2012) Colorectal polyps: when should we tattoo? Surg Endosc 26:3264–3266. https://doi.org/10.1007/s00464-012-2335-z

    Article  PubMed  Google Scholar 

  31. Asgeirsson T (2015) The need for standardization of colonoscopic tattooing of colonic lesions. Dis Colon Rectum 58:268–269. https://doi.org/10.1097/DCR.0000000000000305

    Article  PubMed  Google Scholar 

  32. Elarini T, Wexner SD, Isenberg GA (2015) The need for standardization of colonoscopic tattooing of colonic lesions. Dis Colon Rectum 58:264–267. https://doi.org/10.1097/DCR.0000000000000304

    Article  PubMed  Google Scholar 

  33. CancerCare Manitoba (2019) Manitoba Cancer System Performance Report. Winnipeg

  34. Thor J, Lundberg J, Ask J, Olsson J, Carli C, Härenstam KP, Brommels M (2007) Application of statistical process control in healthcare improvement: systematic review. Qual Saf Health Care 16:387–399

    Article  Google Scholar 

Download references

Funding

This research has been funded in part by a 2019 GFT Research Grant from the Department of Surgery, University of Manitoba.

Author information

Authors and Affiliations

  1. Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, MB, Canada

    Garrett G. R. J. Johnson, Ashley Vergis, Jason Park, Olivia Hershorn, David Hochman & Ramzi M. Helewa

  2. Clinician Investigator Program, University of Manitoba, Winnipeg, MB, Canada

    Garrett G. R. J. Johnson

  3. Department of Internal Medicine, University of Manitoba and University of Manitoba IBD Clinical and Research Center and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Harminder Singh

  4. St. Boniface General Hospital, Z3049 - 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada

    Ramzi M. Helewa

Authors
  1. Garrett G. R. J. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harminder Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashley Vergis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jason Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olivia Hershorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David Hochman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ramzi M. Helewa
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Data were collected by OH and GJ. Manuscript was drafted and data were analyzed by GJ. All authors contributed to study design, critical revision, and final approval of manuscript and agree to be held accountable for all aspects of the work.

Corresponding author

Correspondence to Ramzi M. Helewa.

Ethics declarations

Disclosures

Drs. Johnson, Singh, Vergis, Park, Hershorn, Hochman, and Helewa have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 kb)

Supplementary file2 (DOCX 17 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Johnson, G.G.R.J., Singh, H., Vergis, A. et al. Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study. Surg Endosc 36, 2886–2895 (2022). https://doi.org/10.1007/s00464-021-08580-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08580-1

Keywords

Search

Navigation