P2341 - Are We Screening for Colorectal Cancer During Inpatient Hospital Admissions? 15-year Trends of Inpatient Screening Colonoscopies

Tamta Chkhikvadze, MD¹, Ese Uwagbale, MD², Elmarie Alexander, MD², Junxin Shi, MD, PhD^3
1NYU Grossman School of Medicine, New York, NY; ²One Brooklyn Health System, Brookdale University Hospital and Medical Center, Brooklyn, NY; ³The Research Institute at Nationwide Children's Hospital, Columbus, OH

Introduction: Colorectal cancer screening is mostly performed as an ambulatory same-day procedure and reimbursed as a preventive measure for patients >50 years of age in an average risk population. We attempted to detect and analyze trends of screening colonoscopies performed during inpatient admissions.

Methods: Hospitalization data were extracted from Nationwide Inpatient Sample (NIS) of patients above age 50 years from 2004 to 2018 with associated primary ICD-9 and ICD-10 diagnosis and procedure codes for screening colonoscopy (V76.51; Z12.11; 45.23; 0DJD8ZZ). We stratified age groups into 50-59, 60-69 and above age 70. Sociodemographic data, patients’ primary insurance and median household income by zip code was used as a surrogate endpoint to assess socioeconomic burden and associated trend patterns. Additionally, all associated diagnoses with colonoscopy procedures were analyzed.

Results: A total of nationally estimated 3 315 885 inpatient colonoscopies were identified. Only a minor proportion (27,294) was associated with primary diagnosis of screening for malignant neoplasm of the colon, and the trend has not significantly increased throughout the years (Figure 1). Diverticulosis of colon with hemorrhage (12%), gastrointestinal hemorrhage (9%), melena (3.4%), internal hemorrhoids (3%) and iron deficiency anemia (3%) were 5 top most common associated diagnosis with rest of the procedures. There has been no change in the proportion of colonoscopies performed depending on insurance type, and no increase noted in patients residing in the lowest income areas. Colonoscopy performance increased in males (42% to 47%) and 60-69 age group (21% to 27%), some increase was noted in Black and Hispanic population (Table 1). Procedures have shifted to teaching hospitals from 36% in 2000 to 71.8% in 2018. Mortality remained stable ranging from 1.4% to 1.9% throughout the years.



Discussion: Analysis of inpatient screening colonoscopy hospitalizations >50 years of age throughout 15 years has demonstrated that only ~0.8% of the total colonoscopies were associated with diagnosis of screening for malignancy and no significant increasing trend has been demonstrated throughout 15 years. An increase has been noted in screening minorities and men in 60-69 age group. No increase has been noted for CRC screening of the lowest income population. Analysis is necessary to further determine barriers for performing inpatient screening colonoscopies and capturing more unscreened patients in the >50 years age group.






Figure: Figure 1: Proportion of Inpatient Screening Colonoscopy, NIS 2004-2018

Race	2004 (%)	2018 (%)
White	72.4	68.6
Black	15.2	16.5
Hispanic	8.1	9.4
Asian or Pacific Islander	2.2	2.6
Native American and Others	2.1	2.9

Table: Table 1. Racial distribution of inpatient colonoscopies performed for all associated diagnosis codes, NIS 2004-2018


Disclosures:
Tamta Chkhikvadze indicated no relevant financial relationships.
Ese Uwagbale indicated no relevant financial relationships.
Elmarie Alexander indicated no relevant financial relationships.
Junxin Shi indicated no relevant financial relationships.


Tamta Chkhikvadze, MD¹, Ese Uwagbale, MD², Elmarie Alexander, MD², Junxin Shi, MD, PhD³. P2341 - Are We Screening for Colorectal Cancer During Inpatient Hospital Admissions? 15-year Trends of Inpatient Screening Colonoscopies, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.