Does time of day matter for colonoscopy quality? A review of over 13,000 screening colonoscopies in a colorectal surgery unit

There exists conflicting data in the literature with regard to adequate adenoma detection rate (ADR) as well as other quality metrics during colonoscopy based on the time of day that the procedure is performed. The aim of this study was to investigate the effect of time of day on quality metrics in patients undergoing screening colonoscopy.Screening colonoscopies performed between January 2010 and September 2018 by twenty-eight colorectal surgeons were queried from a prospectively maintained database. Quality parameters examined included adenoma detection rate (ADR), gender-specific ADR, withdrawal time, total examination time, cecal intubation rate, bowel preparation quality, and intra-procedural complications. Colonoscopies were compared between morning (07:30-11:59 AM) and afternoon (12:00-17:00 PM) groups.There were 13,809 endoscopic screening examinations performed in asymptomatic patients older than 45 years. Patients had a mean age of 59.8 years, and 48.5% were female. A total of 8868 (64%) of the scopes were performed in the morning and 4941 (36%) were performed in the afternoon. Median endoscopist volume was 189 [54, 701] and included only surgeons who performed both afternoon and morning colonoscopies. There was no difference in both ADR and bowel preparation quality between the two groups. Both groups exceeded all national quality benchmarks, with the morning group having significantly shorter examination times.In our practice, colonoscopies meet and exceed all national quality benchmarks, independent of the time of day they are performed.