Impact of COVID-19 pandemic on colonoscopy wait times by procedure indication.

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. The differential impact of these interruptions by colonoscopy indication is largely unknown. We aimed to understand the effects of the pandemic on colonoscopy services and patient wait times in Montreal, Canada.

Study: Using 2018-2022 retrospective clinical data from 2 high-volume Montreal endoscopy centres and provincial administrative data, we characterized changes in colonoscopy wait times and the proportion of wait-listed 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 intraCOVID-19 periods. We used time series analysis to characterize trends in the proportion of wait-listed 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 wait-listed patients delayed peaked in 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: Pandemic service disruptions disproportionately impacted symptom assessment procedures and younger patients, resulting in lasting effects. Systematic monitoring of procedures and wait times could facilitate timely detection and intervention to prevent disparities in patient access to care.