Low Incidence of Colorectal Cancer, Elevated Rate of Postprocedure Hospitalization in Elderly Patients Undergoing Surveillance Colonoscopy
In a retrospective cohort study reported in JAMA Internal Medicine, Tran et al found a low rate of colorectal cancer and a relatively high rate of postprocedure hospitalization in elderly patients undergoing surveillance colonoscopy.
Study Details
The study involved patients aged ≥ 50 years undergoing surveillance colonoscopy for a history of colorectal cancer or adenomatous polyps in the Kaiser Permanente Southern California health-care system between 2001 and 2010. Patients were followed from the surveillance examination until colorectal cancer diagnosis, death, disenrollment, inflammatory bowel disease diagnosis, or the end of the study on December 31, 2010. The primary outcome measure was the incidence of colorectal cancer detected following surveillance colonoscopy and the secondary outcome measure was hospitalization within 30 days of the procedure.
The cohort included 4,834 elderly patients aged ≥ 75 years (55.8% male) with a median surveillance age of 79 years and 22,929 patients aged 50 to 74 years (57.7% male) with a median surveillance age of 63 years (reference group).
Colorectal Cancer
Colorectal cancer was found in 5 elderly patients and 368 reference group patients. Colorectal cancer incidence per 1,000 person-years for the elderly group vs reference group was 0.24 vs 3.61 (P < .001). After adjustment for comorbid illness, sex, and race/ethnicity, the hazard ratio for colorectal cancer in the elderly group vs reference group was 0.06 (P < .001).
Hospitalization
Postprocedure hospitalization occurred in 184 elderly patients and 527 reference group patients (3.8% vs 2.3%, P < .001). On multivariate analysis adjusting for race/ethnicity, history of colorectal cancer vs polyps, Charlson comorbidity score, and colorectal cancer risk factors (family history of colorectal cancer or polyps, alcohol abuse, tobacco use, nonsteroidal anti-inflammatory drug use, and body mass index), age ≥ 75 years was an independent predictor of postprocedure hospitalization (adjusted odds ratio [OR] = 1.28, P = .006). Charlson scores of 1 vs 0 (adjusted OR = 1.35, P = .01), 2 vs 0 (adjusted OR = 2.54, P < .001), and 3 vs 0 (adjusted OR = 3.75, P < .001) were also independent predictors of hospitalization.
The investigators concluded: “A low incidence of colorectal cancer and relatively high rate of postprocedure hospitalization were found among elderly patients undergoing surveillance colonoscopy. Recommendations for ongoing surveillance in the elderly population should take into consideration the impact of comorbid illness and increasing age on the anticipated risks and benefits of colonoscopy.”
Bechien U. Wu, MD, MPH, of Kaiser Permanente Los Angeles Medical Center, is the corresponding author for the JAMA Internal Medicine article.
The study was supported by Kaiser Permanente. Dr. Tran received a monetary award in the American Gastroenterology College Colorectal Cancer Prevention Abstract Competition in October 2013, but award money was not used to fund this study.
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