Office-Based Anesthesia for Colonoscopy by Colorectal Surgeons:
Higher Rates of Colon Polyp Detection
Marc Koch, Robert Goldstein, Clifford Gevirtz, Ann Showan, Timothy Hoops, Lee Fleisher

Background: Approximately 75% of all freestanding licensed Ambulatory Surgery Centers offer colonoscopy and gastroscopy services. A large number of endoscopy procedures are also performed in Office-Based Surgical Facilities (OBSF). Anesthesiologists are often called upon to provide services for these procedures, especially in the OBSF venue, where the breadth and depth of emergency resources are scant compared to more traditional venues. Beyond its impact on patient satisfaction, divestiture of anesthesia to an independent anesthesiologist permits endoscopists to focus on single task –polyp detection. This study evaluates the immediate impact of initiation of office-based anesthesiology (OBA) service on colon polyp detection in the OBSF setting.
Methods: We studied the records of 548 patients of four colorectal surgeons who commenced de novo OBA services in their OBSF between April and August of 2002, and continuously maintained the service for at least 4 consecutive months. A propofol technique was used for all patients wherein they were generally unconscious to tactile or verbal stimuli during uncormfortable portions of the procedure. The first full month of coverage was designated as the baseline and for this and each of the next three months, data was acquired through extraction from our billing database (Northern Health Solutions). For each month, information was gathered on the number of patients in whom at least one polyp was identified (ICD-9-CM code 211,3) vs. the number of patients in whom none was detected. Each of these respective values was divided by the total number of patients studied to arrive at detection rate. Average age and gender of patients were also collected.
Results: Patients in whom at least one polyp was detected vs. the number of patients in whom no polyps were detected, and these values were divided by the total number of patients cared for. For 1st, 2nd, 3rd and 4th months the detection rates were 36/154 (23.4%), 44/150 (29.3%), 43/127 (33.9%), and 54/117 (46.2%), respectively. Using a two-tail test and a 90% confidence level, by the third and fourth month of coverage, a
statistically significant increase in polyp detection was seen when compared to the first (baseline) full month of coverage.
Conclusion: In this study of patients for whom colorectal surgeons initially provided their own anesthesia while performing colonoscopy in their OBSF, the delegation of anesthesia to an Anesthesiologist resulted in improved colon polyp detection. Although this may be partly due to anesthesia technique, the medications used or other factors, this finding also may be consistent with the well-known shortcomings of multitasking. These data suggest that an environment devoid of clinical multitasking may lead to the discovery of more polyps and enhance cancer detection and prevention.

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