Association of life expectancy with surveillance colonoscopy findings and follow-up recommendations in older adults
Key points
Is estimated life expectancy associated with surveillance colonoscopy findings and recommendations for follow-up colonoscopy in older adults?
Findings
In this cohort study of 9,831 adults aged 65 years and older in New Hampshire, 8% had advanced polyps or colorectal cancer during surveillance colonoscopy. Most patients were recommended to return for a future colonoscopy, even if life expectancy was limited.
Meaning
These findings suggest that recommending against future surveillance colonoscopy in older adults with low-risk colonoscopy findings and/or limited life expectancy should be considered more frequently than is currently practiced.
Importance
Surveillance after previous colon polyps is the most common indication for colonoscopy in older adults. However, to our knowledge, the current use of surveillance colonoscopy, clinical outcomes, and follow-up recommendations in relation to life expectancy, taking into account age and comorbidities, have not been studied.
Aim
To evaluate the association of estimated life expectancy with surveillance colonoscopy findings and follow-up recommendations among older adults.
Design, environment and participants
This registry-based cohort study used data from the New Hampshire Colonoscopy Registry (NHCR) linked to Medicare claims data and included adults in the NHCR who were older than 65 years, underwent colonoscopy for surveillance after previous polyps among April and December 1, 2009 and December 31, 2018, and had full Medicare Parts A and B coverage and was not enrolled in a Medicare managed care plan in the year before the colonoscopy. Data was analyzed from December 2019 to March 2021.
Exhibitions
Life expectancy (<5 years, 5 to <10 years, or ≥10 years), estimated using a validated prediction model.
Main results and measures
The main outcomes were clinical findings of colon polyps or colorectal cancer (CRC) and recommendations for future colonoscopies.
Results
Among the 9,831 adults included in the study, the mean (SD) age was 73.2 (5.0) years and 5,285 (53.8%) were men. A total of 5,649 patients (57.5%) had an estimated life expectancy of 10 or more years, 3,443 (35.0%) from 5 to less than 10 years, and 739 (7.5%) less than 5 years. .
In total, 791 patients (8.0%) had advanced polyps (768 [7.8%]) or CRC (23 [0.2%]).
Among the 5,281 patients with available recommendations (53.7%), 4,588 (86.9%) were recommended to return for a future colonoscopy.
Those with a longer life expectancy or more advanced clinical findings were more likely to be told to return. For example, among patients with no polyps or only small hyperplastic polyps, 132 of 227 (58.1%) with a life expectancy of less than 5 years were told to return for a future surveillance colonoscopy versus 940 of 1,257 (74.p < 0.001).
Conclusions and relevance In this cohort study, the probability of finding advanced polyps and colorectal cancer (CRC) at surveillance colonoscopy was low , regardless of life expectancy. Despite this observation, 58.1% of older adults with less than 5 years of life expectancy were recommended to return for a future surveillance colonoscopy. These data may help refine decision-making about continuing or stopping surveillance colonoscopy in older adults with a history of polyps. |
