P1468 - COVID-19 and Its Effect on Endoscopic Peri-Procedural Times Based on the American Society of Anesthesiologists Physical Status Classification: A Single Center Experience

Camille H. Boustani, MD¹, William D. Davis, DO¹, Mark Real, MD¹, Ahmed Alsaiari, MD¹, Kristofer Muzzi, BS¹, Lelan Bailey, BA¹, Joseph J. Jennings, MD^2
1MedStar Georgetown University Hospital, Washington, DC; ²Georgetown University Hospital, Washington, DC

Introduction: Endoscopy centers have had to adjust common practices during the COVID-19 pandemic in order to mitigate the risk of transmission while optimizing layout to maintain efficiency. Pre-procedural testing, changes in endoscopy structure and staff, downtime for cleaning, and a limited number of negative pressure rooms have presented new challenges. The purpose of our study is to compare outpatient peri-procedure times before and during COVID-19, to determine if any significant differences would be present.

Methods: Our study is a retrospective, single center analysis utilizing endoPRO software to extract individual patient data during the months of October in 2019 and 2020. These two months were chosen since they reflect a pre-COVID-19 and COVID-19 time period. The study included patients that underwent various endoscopic procedures in an outpatient setting. A total of 1769 procedures were classified into two groups, either American Society of Anesthesiologists Physical Status (ASA-PS) 1 and 2 (n=1087), or ASA-PS 3 and 4 (n=679), as determined by pre-procedure anesthesia assessment. Patients were further divided into year 2019 and year 2020 subgroups. Table 1 shows the outcomes of interest that were analyzed, which was performed using a two-sample t-test with Python programming language.

Results: The analysis is presented in Table 1. Comparing outpatient procedures across all ASA-PS, those in 2020 had statistically significant longer time intervals for many of the outcomes of interest, as shown in Table 1 (p < 0.05). Stratifying by ASA-PS 1 and 2 in each year, procedures in 2020 also had longer outcomes of interest. Selecting for colonoscopies only, our data also demonstrates longer time intervals in multiple subcategories when comparing 2020 to 2019.

Discussion: Our single center retrospective analysis establishes that outpatient peri-procedure times in October of 2020 were considerably longer compared to those in October of 2019. Grouping the data further by similar ASA-PS and type of procedure still showed longer endoscopy suite preparation and post-procedural times in 2020. This period represents a time when COVID-19 has caused substantial disruption to regular endoscopy workflow and efficiency. One notable difference was that the procedure time for a colonoscopy in October of 2020 was 23.2 minutes, compared to 19.6 minutes in 2019. We hypothesize that there were likely fewer screening colonoscopies being performed in 2020 versus 2019, which may be accounting for some of the difference.

Time (Minutes)	2019 (All procedures)	2020 (All procedures)	P Value	2019 (All procedures)	2020 (All procedures)	P Value	2019 (Colonoscopy)	2020 (Colonoscopy)	P Value
	ASA 1-4 (N=898) Mean	ASA 1-4 (N=871) Mean		ASA 1-2 (N=573) Mean	ASA 1-2 (N=514) Mean		ASA 1-4 (N=472) Mean	ASA 1-4 (N=457) Mean
Registration	11.7	14.4	8.13 x 10-8	11.0	13.7	4.221 x 10-6	11.2	14.0	0.0001
Waiting room	32.5	37.1	0.00034	31.6	36.7	0.0012	28.4	37.1	7.47 x 10-8
Preparation	18.5	17.3	0.012	17.6	16.5	0.0601	18.1	16.7	0.025
Waiting for endoscopy room	15.1	18.5	0.0001	14.9	19.0	0.0002	14.6	17.2	0.022
Endoscopy room setup	4.7	4.6	0.634	4.4	4.2	0.5368	4.7	4.2	0.123
Physician arrival	7.1	6.1	0.033	6.5	6.1	0.3449	6.8	6.13	0.131
In room delay	6.5	7.5	0.0074	5.7	7.1	0.0015	6.9	7.8	0.090
Procedure	17.2	19.6	5.63 x 10-6	16.3	19.2	1.183 x 10-5	21.1	23.5	0.0006
Post procedure	18.8	20.2	0.167	18.1	19.4	0.2774	15.4	15.5	0.961
Last endoscopy image capture	18.3	18.2	0.810	16.6	17.4	0.1576	18.4	18.1	0.656

Table: Table 1


Disclosures:
Camille Boustani indicated no relevant financial relationships.
William Davis indicated no relevant financial relationships.
Mark Real indicated no relevant financial relationships.
Ahmed Alsaiari indicated no relevant financial relationships.
Kristofer Muzzi indicated no relevant financial relationships.
Lelan Bailey indicated no relevant financial relationships.
Joseph Jennings indicated no relevant financial relationships.


Camille H. Boustani, MD¹, William D. Davis, DO¹, Mark Real, MD¹, Ahmed Alsaiari, MD¹, Kristofer Muzzi, BS¹, Lelan Bailey, BA¹, Joseph J. Jennings, MD². P1468 - COVID-19 and Its Effect on Endoscopic Peri-Procedural Times Based on the American Society of Anesthesiologists Physical Status Classification: A Single Center Experience, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.