eP675 - Characterizing Factors That Impact Post-Resection Surveillance Colonoscopy

Purpose/Background: Surveillance colonoscopy is recommended for patients with Stage I-III colorectal cancer (CRC) within one year following resection of the tumor. Retrospective studies have suggested approximately 50% of patients are compliant with this recommendation. We aimed to determine rates of surveillance colonoscopy after CRC resection at our institution, with the goal of describing system-level factors associated with missed or delayed colonoscopy.Methods/Interventions: We conducted a retrospective cohort analysis of patients from a single center who underwent resection for stage I-III colorectal cancer from January 2018-December 2021. Exclusion criteria included patients with metastatic disease, patients who had follow up at an outside hospital with missing records, patients with neuroendocrine tumors, and those who died within one year of resection. We described rates of missing colonoscopy and time to surveillance colonoscopy from date of resection. We explored system-related variables associated with missing or delayed colonoscopy including the provider performing resection/surveillance, presentation at tumor board, cancer stage, colon v rectal cancer, and year of resection.Results/Outcomes: There were 249 patients with a mean age of 62 +/-13 years, 102 (41%) were female. Of those patients, 45 (18%) did not complete any follow up surveillance colonoscopy. By 12 and 18 months post resection 149 (59%) and 62 (24%) had not completed a surveillance colonoscopy, respectively. Missing colonoscopy was highest for surgical resections performed in 2019 at 17 (24.6%). Figure 1 highlights missing colonoscopy rates by year.Patients who were not presented at tumor board were more likely to never have a surveillance colonoscopy compared to those presented (23% v 14%, p=0.04). Rates of missing colonoscopy were not associated with colon or rectum tumor location (18% v 18%, p=0.98), stage of cancer (I: 18%, II: 18%, III: 19%, p=0.98), or whether resection was performed by a general or colorectal surgeon (17% v 18%, p=0.78). Surveillance colonoscopy beyond 18 months was also not significantly associated with tumor location (23% v 28%, p=0.326), stage of cancer (I: 24%, II: 27%, III: 25%, p=0.68), or whether resection was performed by a general or colorectal surgeon (24% v 25%, p=0.89), or whether the same provider did surgery/surveillance (7% v 9%, p=0.43).Conclusion/

Discussion: While the majority of patients did not complete a surveillance colonoscopy within 1 year post resection, most completed it by 18 months. Still, almost 1 in 5 patients never completed a surveillance colonoscopy after resection. In this cohort, presentation at tumor board was associated with reduced likelihood of missing a colonoscopy. Whether the delay in colonoscopy to 18 months has meaningful clinical implications, and what patient factors can explain the residual missing colonoscopies, warrants further investigation.Figure 1Trends of missing and delayed colonoscopy by year