Supplementary Online Content Tran AH, Ngor EWM, Wu BU. Surveillance colonoscopy in elderly patients: a retrospective cohort study. JAMA Intern Med. Published online August 11, 2014. doi:10.1001/jamainternmed.2014.3746 eappendix 1. Abbreviations eappendix 2. CPT and ICD-9-CM Codes etable 1. Primary Diagnoses of Hospitalized Patients, Individual Chart Review etable 2. Procedure-Related Complications etable 3. Gastrointestinal-Related Causes for Hospitalizations etable 4. Other Causes for Hospitalizations etable 5. Demographics and CRC Incidence in Colorectal Cancer Group vs Polyp Group etable 6. Demographics, CRC Incidence and Hospitalization Based on Gender etable 7. Gender-Based CRC Incidence Rate efigure. Hospitalized Patients Within 30 Days of Surveillance Exam and Incidence of CRC This supplementary material has been provided by the authors to give readers additional information about their work.
Appendix 1. Abbreviations SBO=small bowel obstruction, GI: gastrointestinal, IBD: inflammatory bowel disease, COPD: chronic obstructive pulmonary disease, ACS: acute coronary syndrome, CVA: cardiovascular attack, CHF: congestive heart failure, ASA: aspirin, AMS: altered mental status, PE: pulmonary embolism, DVT: deep venous thrombosis, SIADH: syndrome of inappropriate anti-diuretic hormone, MM: multiple myeloma eappendix 2 ICD Codes CPT-procedure codes for polypectomy/biopsies 45380: colonoscopy with biopsy, single or multiple 45385: colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), lesion(s) by snare technique 45383: colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion (s) not amendable to removal by hot biopsy forceps, bipolar cautery or snare technique 45384: colonoscopy, flexible, proximal to splenic flexure; with removal of tumor (s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery 45378: Colonoscopy, flexible, proximal to the splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression. ICD 9 codes for personal history of polyps and CRC V12.72: Personal history of colonic polyps V10.0: Personal history of malignant neoplasm of GI tract V10.00: personal history of malignant neoplasm of GI tract, unspecified V10.05: Personal history of malignant neoplasm of large intestine V10.06 Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus V10.09 Personal history of malignant neoplasm of other gastrointestinal tract ICD 9 codes for family history of polyps and CRC V18.51: family history of colonic polyps V16.0: family history of malignant neoplasm of GI tract ICD 9 codes for diagnosis of polyps and CRC 153 Malignant neoplasm of colon 153.0 Malignant neoplasm of hepatic flexure 153.1 Malignant neoplasm of transverse colon 153.2 Malignant neoplasm of descending colon 153.3 Malignant neoplasm of sigmoid colon 153.4 Malignant neoplasm of cecum 153.5 Malignant neoplasm of appendix vermiformis 153.6 Malignant neoplasm of ascending colon 153.7 Malignant neoplasm of splenic flexure 153.8 Malignant neoplasm of other specified sites of large intestine 153.9: Malignant neoplasm of colon, unspecified site
211 Benign neoplasm of other parts of digestive system 211.2 Benign neoplasm of duodenum, jejunum, and ileum 211.3 Benign neoplasm of colon 211.4 Benign neoplasm of rectum and anal canal 211.9 Benign neoplasm of other and unspecified site in the digestive system 154 Malignant neoplasm of rectum rectosigmoid junction and anus 154.0 Malignant neoplasm of rectosigmoid junction 154.1 Malignant neoplasm of rectum 154.2 Malignant neoplasm of anal canal 154.3 Malignant neoplasm of anus, unspecified site 154.8 Malignant neoplasm of other sites of rectum, rectosigmoid junction, and anus ICD 9 codes for GI bleed 578: GI hemorrhage 578.9 : hemorrhage of GI tract unspecified 578.1: blood in stool ICD 9 codes for GI risk factors V15.82: personal history of tobacco use 305.1: tobacco use disorder 278 Overweight, obesity and other hyperalimentation 278.0 Overweight and obesity 278.00 Obesity, unspecified 278.01 Morbid obesity 278.02 Overweight 305.0 Nondependent alcohol abuse 305.00 Alcohol abuse, unspecified 305.01 Alcohol abuse, continuous 305.02 Alcohol abuse, episodic 305.03 Alcohol abuse, in remission V58.64 Long term (current) use of non-steroidal anti-inflammatories (NSAID) ICD 9 codes for inflammatory bowel disease 556.0, Ulcerative (chronic) enterocolitis; 556.1, Ulcerative (chronic) ileocolitis; 556.2, Ulcerative (chronic) proctitis; 556.3, Ulcerative (chronic) proctosigmoiditis; 556.4, Pseudopolyposis of colon; 556.5, Left-sided ulcerative (chronic) colitis; 556.6, Universal ulcerative (chronic) colitis (pancolitis) 556.8, Other ulcerative colitis 556.9, Ulcerative colitis, unspecified. 555.0, Crohn s disease of small intestine, including duodenum, ileum, and jejunum (regional ileitis); 555.1, Crohn s disease of large intestine (regional colitis); 555.2, Crohn s disease of small intestine with large intestine (regional ileocolitis); and 555.9, Crohn s disease of unspecified site (regional enteritis, not otherwise specified).
etable 1. Primary Diagnoses of Hospitalized Patients, individual chart review No Records (unable to determine main cause of admission) Including all cause hospitalizations (N=711) % hospitalized (N=711) 170 23.9% Other 214 30.1% Procedure related 92 13.0% GI related 235 33.0% etable 2. Procedure-related complications Procedure Complications (N=92) Percent GI bleeding after biopsy or polypectomy 68 73.91% GI perforation 19 20.65% Abdomen pain, nausea, emesis, ileus 4 4.35% Arrthymia 1 1.09% etable 3. Gastrointestinal-related causes for hospitalizations GI causes for hospitalizations (N=235) GI surgery 156 Colonoscopy 1 SBO 6 GI bleed 27 Volvulus 1 Diverticulitis 4 Pancreatitis 4 Colostomy adjustment 7 Abdomen pain, nausea, emesis, diarrhea 13 Cholecystitis/Choledocholithiasis 5 GI cancer 3 Liver disease 2 Appendicitis 3 Constipation 1 Perforation of ulcer 1 New diagnosis of IBD 1 Total 235
etable 4. Other causes for hospitalizations Other (N=214) joint replacement surgery 12 Infections 26 Prostate surgery 14 Bladdery surgery 3 Other surgeries 36 COPD Exacerbation 3 Chest pain/acs rule out/arrthymias 49 Anemia work up 2 Fall 3 CVA 10 CHF 5 ASA densitization 1 Hematuria 2 Kidney stones 3 Syncope/Pre-syncope symptoms 10 Dyspnea/Respiratory failure 7 Angioedema 1 Clots: PE/DVT 3 Renal Failure 4 Hypoglycemia 2 Epitaxis 1 Eye problems 2 Weakness 1 AMS/Intoxication 4 Thyroid ablation 1 Intracranial bleed 2 SIADH 1 Brain tumor 1 Leukemia/MM/Lymphoma 4 Spinal Stenosis 1 Total 214
etable 5. Demographics and CRC incidence in Colorectal Cancer group vs polyp group Characteristics Personal history of polyps or CRC CRC (N=3073) Polyp (N=24690) Total (N=27763) pvalue Mean (SD) 69.7 (9.80) 65.6 (8.65) 66.0 (8.88) Median 70.1 (62.3-77.3) 65.2 (58.7-71.9) 65.7 (59.0-72.5) Range (50.0-98.4) (50.0-94.9) (50.0-98.4) Age group 50-54 261 (8.5%) 3137 (12.7%) 3398 (12.2%) 54-59 327 (10.6%) 4152 (16.8%) 4479 (16.1%) 60-64 432 (14.1%) 4838 (19.6%) 5270 (19%) 64-69 506 (16.5%) 4723 (19.1%) 5229 (18.8%) 70-74 555 (18.1%) 3998 (16.2%) 4553 (16.4%) 75+ 992 (32.3%) 3842 (15.6%) 4834 (17.4%) Gender F 1502 (48.9%) 10322 (41.8%) 11824 (42.6%) M 1571 (51.1%) 14368 (58.2%) 15939 (57.4%) Race/ethnicity Asian Pacific Island 231 (7.5%) 2004 (8.1%) 2235 (8.1%) Black 370 (12%) 2818 (11.4%) 3188 (11.5%) Hispanic 415 (13.5%) 3452 (14%) 3867 (13.9%) Other/Unknown 157 (5.1%) 2170 (8.8%) 2327 (8.4%) White 1900 (61.8%) 14246 (57.7%) 16146 (58.2%) Category of Charlson's index 0 1002 (32.6%) 15087 (61.1%) 16089 (58%) 1 280 (9.1%) 4294 (17.4%) 4574 (16.5%) 2 752 (24.5%) 2937 (11.9%) 3689 (13.3%) >=3 1039 (33.8%) 2372 (9.6%) 3411 (12.3%) Alcohol abuse 80 (2.6%) 611 (2.5%) 691 (2.5%) 0.666 Tobacco use 918 (29.9%) 4926 (20%) 5844 (21%) Overweight/obese 830 (27%) 5033 (20.4%) 5863 (21.1%) NSAID use 10 (0.3%) 17 (0.1%) 27 (0.1%) Family history of CRC/polyps 460 (15%) 3357 (13.6%) 3817 (13.7%) 0.037 CRC 43 (1.4%) 330 (1.3%) 373 (1.3%) 0.776 Age < 75 N 2081 20848 22929 0.116 CRC, N (%) 42 (2.0%) 326 (1.6%) 368 (1.6%) Age >=75 N 992 3842 4834 1.000 CRC, N (%) 1 (0.1%) 4 (0.1%) 5 (0.1%) Length of follow up Mean (SD) 38.8 (22.93) 54.9 (32.63) 53.1 (32.11) Median 39.2 (19.4, 56.0) 54.4 (25.1, 80.4) 52.3 (23.5, 76.8) Range 119.9) 119.9) 119.9)
etable 6. Demographics, CRC incidence and hospitalization based on gender Characteristics Male Total <75 >=75 (N=15939 p value (N=13241) (N=2698) ) <75 (N=9688) Female >=75 (N=2136) Total (N=11824) p value 79.5 66.1 79.7 Mean (SD) 63.3 (6.78) 63.0 (6.76) 66.0 (9.01) (3.50) (8.78) (3.57) Median 63.6 78.7 65.9 63.2 79 65.5 Range (50.0 75.0) (75.0 97.1) (50.0 97.1) (50.0 75.0) (75.0 98.4) (50.0 98.4) Age group 50 54 54 59 60 64 64 69 70 74 1906 (14.4%) 2561 (19.3%) 2964 (22.4%) 3080 (23.3%) 2730 (20.6%) 75+ 2698 (100%) 1906 (12%) 2561 (16.1%) 2964 (18.6%) 3080 (19.3%) 2730 (17.1%) 2698 (16.9%) 1492 (15.4%) 1918 (19.8%) 2306 (23.8%) 2149 (22.2%) 1823 (18.8%) 2136 (100%) 1492 (12.6%) 1918 (16.2%) 2306 (19.5%) 2149 (18.2%) 1823 (15.4%) 2136 (18.1%) Race/ethnicity 1128 183 1311 109 Asian Pacific Island 815 (8.4%) 924 (7.8%) (8.5%) (6.8%) (8.2%) (5.1%) 1363 231 1594 1317 1594 Black 277 (13%) (10.3%) (8.6%) (10%) (13.6%) (13.5%) 285 2143 1495 229 1724 Hispanic 1858 (14%) (10.6%) (13.4%) (15.4%) (10.7%) (14.6%) 1274 1383 102 Other/Unknown 109 (4%) 842 (8.7%) 944 (8%) (9.6%) (8.7%) (4.8%) 7618 1890 9508 5219 1419 6638 White (57.5%) (70.1%) (59.7%) (53.9%) (66.4%) (56.1%) Personal history of polyp or CRC 1084 487 1571 997 505 1502 CRC (8.2%) (18.1%) (9.9%) (10.3%) (23.6%) (12.7%) Polyp 12157 (91.8%) 2211 (81.9%) 14368 (90.1%) 8691 (89.7%) 1631 (76.4%) 10322 (87.3%)
Characteristics Male Total <75 >=75 (N=15939 p value (N=13241) (N=2698) ) <75 (N=9688) Female >=75 (N=2136) Total (N=11824) p value Category of Charlson's index 0 8009 1056 9065 6024 1000 7024 (60.5%) (39.1%) (56.9%) (62.2%) (46.8%) (59.4%) 1 2178 469 2647 1561 366 1927 (16.4%) (17.4%) (16.6%) (16.1%) (17.1%) (16.3%) 2 1626 486 2112 1187 390 1577 (12.3%) (18%) (13.3%) (12.3%) (18.3%) (13.3%) >=3 1428 687 2115 380 916 (9.5%) (10.8%) (25.5%) (13.3%) (17.8%) 1296 (11%) Alcohol abuse 477 (3.6%) 88 (3.3%) 565 (3.5%) 0.3829 111 (1.1%) 15 (0.7%) 126 (1.1%) 0.0708 Tobacco use 3059 733 3792 1693 359 2052 (23.1%) (27.2%) (23.8%) (17.5%) (16.8%) (17.4%) 0.4605 Overweight/obese 2691 436 3127 2325 411 2736 (20.3%) (16.2%) (19.6%) (24%) (19.2%) (23.1%) NSAID use 3 (0%) 7 (0.3%) 10 (0.1%) 0.0003 11 (0.1%) 6 (0.3%) 17 (0.1%) 0.1041 Family history of 1620 234 1854 1683 280 1963 CRC/polyps (12.2%) (8.7%) (11.6%) (17.4%) (13.1%) (16.6%) Outcomes CRC 221 (1.7%) 4 (0.1%) 225 (1.4%) 147 (1.5%) 1 (0%) 148 (1.3%) Hospitalized within 30 days 107 420 313 (2.4%) after surveillance (4.0%) (2.6%) 214 (2.2%) 77 (3.6%) 291 (2.5%) 0.0002 colonoscopy
etable 7. Gender-based CRC incidence rate Incidence rate of CRC per gender Male Female <75 >=75 Total P value <75 >=75 Total P value Length of follow up (mos) 0.4298 Mean (SD) 53.6 53.0 53.5 53.6 53.0 53.5 (32.24) (30.35) (31.91) (32.24) (30.35) (31.91) Median 52.8 52.1 52.7 52.8 52.1 52.7 Range 119.9) 119.5) 119.9) 119.9) 119.5) 119.9) CRC Total follow up (person years) Incidence rate (1000 personyears) Incidence rate (100,000 person years) 221 (1.7%) 4 (0.1%) 225 (1.4%) 147 (1.5%) 1 (0%) 148 (1.3%) 58768.67 11345.83 70114.50 43257.53 9430.18 52687.71 3.76 0.35 3.21 <.0001 3.398 0.106 2.809 0.0005 376.0507 246 35.25524 356 320.9036 762 339.8252 10.6042 280.9004
efigure. Hospitalized patients within 30 days of surveillance exam and incidence of CRC efigure: Bar graph demonstrating percent of hospitalization and detection of CRC on surveillance exam by 5 year age interval. Comparison between the younger and older cohorts find older cohort with decrease in incidence of CRC and increasing incidence of hospitalizations (p value < 0.0001)