Impact of COVID-19 Pandemic on Colonoscopy Wait Times by Procedure Indication

Melina Thibault, Alan Barkun, Myriam Martel, Alton W. Russell
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Abstract

Background: Patients are referred for colonoscopy for symptom assessment, screening, and surveillance. Public health measures to mitigate the spread of the COVID−19 pandemic disrupted services and increased patient delays for colonoscopy services in Quebec. The differential impact of these interruptions by colonoscopy indication is largely unknown. Methods: Using 2018−2022 retrospective clinical data from two high-volume Montreal endoscopy centres and provincial administrative data, we characterized changes in colonoscopy wait times and the proportion of waitlisted patients who were delayed (wait time exceeded provincial guidelines) by procedure indication and demographics. We used regression to examine patient characteristics associated with delayed procedures during pre- and intra−COVID−19 periods. We used time series analysis to characterize trends in the proportion of waitlisted patients delayed. Results: The COVID-19−related public health measures resulted in record-high delays (median increase in wait times of 34−159% across indications). While older patients experienced longer wait times pre-pandemic, intra−COVID−19 wait times increased disproportionately for patients younger than 50. The proportion of waitlisted patients delayed peaked mid−2020 (56.9% for screening; 56.0% for symptom assessment patients). By early 2022, the proportion delayed had fallen to 37.3% for screening patients but remained at 53.8% for symptom assessment patients. Conclusions: In Quebec, intra-COVID-19 colonoscopy delays disproportionately impacted symptom assessment procedures and younger patients. Additional capacity or improved triaging may be needed to address persistent delays. Understanding the effects of the pandemic on colonoscopy services can help inform strategies to mitigate harms from on-going delays in Quebec.
按手术指征分列的 COVID-19 大流行对结肠镜检查等待时间的影响
背景:患者被转诊接受结肠镜检查,以进行症状评估、筛查和监测。在魁北克省,为减少 COVID-19 大流行病的传播而采取的公共卫生措施中断了结肠镜检查服务并增加了患者就诊时间。根据结肠镜检查适应症的不同,这些中断造成的不同影响在很大程度上是未知的。方法:利用蒙特利尔两家高流量内镜检查中心提供的 2018-2022 年回顾性临床数据和省级行政数据,我们按手术指征和人口统计学特征描述了结肠镜检查等待时间的变化以及被延误(等待时间超过省级指南)的候诊患者比例。我们使用回归分析法研究了在 COVID-19 之前和期间与延迟手术相关的患者特征。我们使用时间序列分析法来描述候诊患者延误比例的变化趋势。结果:与 COVID-19 相关的公共卫生措施导致了创纪录的高延误率(各种适应症的等待时间中位数增加了 34-159%)。虽然大流行前年龄较大的患者等待时间较长,但在 COVID-19 期间,50 岁以下患者的等待时间增加得不成比例。2020 年年中,延误等待的患者比例达到顶峰(筛查患者为 56.9%;症状评估患者为 56.0%)。到 2022 年初,筛查患者的延误比例降至 37.3%,但症状评估患者的延误比例仍为 53.8%。结论:在魁北克,COVID-19 期间结肠镜检查的延误对症状评估程序和年轻患者的影响尤为严重。可能需要增加能力或改进分流来解决持续的延误问题。了解大流行病对结肠镜检查服务的影响有助于为魁北克省减轻持续延误带来的危害的策略提供依据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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