Background and Aims
There are few data on the quality of EUS in the community setting. We characterized
EUS performance at the individual facility level in 3 large American states, using
need for repeat biopsy (NRB) as a metric for procedural failure, and the rate of unplanned
hospital encounters (UHEs) as a metric for adverse events.
Methods
We collected data on 76,614 EUS procedures performed at 166 facilities in California,
Florida, and New York (2009-2014). The endpoints for the study were 7-day rate of
UHEs after EUS, and 30-day rate of NRB after EUS with fine-needle aspiration. Facility-level
factors analyzed included annual procedure volume, urban/rural location, and free-standing
status (facilities not attached to a larger hospital). Predictors for UHE and NRB
were analyzed in both multivariable regression and nonparametric local regression.
Results
Facility volume did not predict risk for UHEs. However, high facility volume protected
against NRB (P trend <.001) even after adjustment for other facility-level factors. When regressing
facility volume against risk for NRB in local regression, a join point (inflection
point) was identified at 97 procedures per annum. Once facilities reached this threshold
volume, there appeared little additional protective effect of higher volume. Rural
facility location (odds ratio, 1.81; 95% confidence interval, 1.36-2.40) and free-standing
status (odds ratio, 1.57; 95% confidence interval, 1.16-2.13) were also associated
with NRB.
Conclusion
Facility volume does not predict risk for adverse events after EUS. However, high
facility volume is associated with decreased rates of technical failure (as assessed
by NRB). These data provide one of the first descriptions of EUS practice in community
settings and highlight opportunities to improve endoscopic quality nationally.
Abbreviations:
ASC (ambulatory surgery center), ASGE (American Society for Gastrointestinal Endoscopy), CI (confidence interval), CPT (Current Procedural Terminology), ICD-9-CM (International Classification of Disease 9th Revision Clinical Modification), LOESS (local regression), NRB (need for repeat biopsy), OR (odds ratio), UHE (unplanned hospital encounter)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 18, 2021
Accepted:
December 31,
2020
Received:
August 26,
2020
Footnotes
If you would like to chat with an author of this article, you may contact Dr Banerjee at subhas.ban [email protected]
DISCLOSURE: Dr Park is a consultant for Olympus. All other authors disclosed no financial relationships.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
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- Improving quality in EUS: a call for a national benchmarking registryGastrointestinal EndoscopyVol. 94Issue 1
- PreviewEUS and EUS-guided tissue acquisition (EUS-TA) have become central techniques in the assessment of GI and non-GI malignancies and numerous nonmalignant processes.1,2 We continue to observe an exponential increase in EUS procedure volumes in the United States coupled with an increase in the number of endoscopists trained in EUS and improvement in the devices required for EUS-TA.3 In keeping with the unprecedented increased focus on quantifying and improving the quality of healthcare and the trend in the United States to move toward a high-value care platform from a system centered on high-volume care, quality indicators (QIs) for EUS have been established.
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