S330 Higher Comorbidity Is Associated With Improved Surveillance Colonoscopy Attendance

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Introduction: Current guidelines recommend that surveillance colonoscopy after polypectomy should be discontinued when risks outweigh benefits. Yet, there is no widely accepted tool to assess continued surveillance risk or utility, leaving physicians to decide to continue or discontinue surveillance based on subjective individualized assessments. One way to assess utility of continued surveillance is to assess the likelihood of attendance of a next recommended surveillance colonoscopy (NRSC). We evaluated the ability of the Charlson Comorbidity Index (CCI) to predict whether patients would attend their NRSC. We hypothesized that patients with greater CCI would be less likely to attend their NRSC. Methods: We conducted a retrospective cohort study of patients from our institution 60 years of age or older with a history of colon polyps and at least one prior colonoscopy in our system with a follow-up colonoscopy recommended at a specified time interval. We used receiver-operating characteristic analysis to test for a CCI value that best predicted attendance of the NRSC. Results: Of the 852 patients with a history of polyps who underwent at least one colonoscopy, 136 (16%) were not recommended a follow-up colonoscopy at a specified time interval. Of those who did have a follow-up surveillance colonoscopy recommended, 236 (33%) attended their NRSC, 205 (29%) did not attend, and 275 (38%) patients had NRSC that was not yet due at the time of analysis. In the overall cohort of patients who either did or did not attend their NRSC (n = 441), there was a non-significant trend for greater comorbidity to predict increased likelihood of attendance (CCI > 5 OR 1.26, AUC 0.527, P = 0.243). Likelihood of attendance decreased as recommended interval to next colonoscopy increased (P = 0.046). For patients recommended a follow-up colonoscopy in 5 years (n = 194), those with higher comorbidity (CCI > 5) were more likely to attend NRSC than not (OR 2.06, AUC 0.58, P = 0.017) (Table). Conclusion: Patients with greater comorbidity may be more likely to attend NRSC than not. Exact reasons for this are unclear but could include greater self-perceived risk of colorectal cancer (CRC) and increased interaction with the healthcare system. While past research has shown that patients with > 5 comorbidities are less likely to be screened for CRC, this group of patients may be more likely to adhere to recommended surveillance colonoscopy following polypectomy.Table 1.: Relationship between Charlson Comorbidity Index and Attendance of Surveillance Colonoscopy at Five-Year Intervals.

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