S332 Determining the Profile of Patients Lost in Follow-up after the Resection of High-Risk Colonic Polyps

Introduction: Colorectal cancer is the third cause of cancer-related mortality in the United States. Non-pedunculated polyps ≥20 mm have increased risk of recurrence; hence, surveillance colonoscopy is recommended at 6 months. Unfortunately, patient follow up after resection of these high-risk polyps is not perfect. We aim to study the characteristics of patients who were lost in follow up after resection of non-pedunculated polyps ≥20 mm at a safety-net and Veteran’s Affairs (VA) hospitals, with the purpose of developing qualitive improvement interventions targeting these patients. Methods: Retrospective study of patients who undergone endoscopic mucosal resection of non-pedunculated polyps larger ≥20 mm at a safety-net and VA hospital in Houston, Texas from 2012 to 2019. Patients who had two stage procedures, non-neoplastic histology or evidence of invasive cancer were excluded. Patients were divided by competition of at least 1 surveillance colonoscopy. Demographic data, polyp and resection characteristics were analyzed. Distance to hospital and income was calculated based on zip code. Univariate and multivariate analyzed were performed. Results: A total of 522 non-pedunculated polyps were included from 468 unique patients. 328 lesions completed at least one surveillance colonoscopy and 194 did not follow up. Patients who did not follow up were more likely to be younger male, uninsured, and had longer driving time and distance to the hospital. Ethnicity, need of English interpreter and average income was comparable between groups. Polyps larger in size, in the right colon, removed by piecemeal resection and with high grade dysplasia were more likely to have at least 1 surveillance colonoscopy (Table). After multivariable analysis, male gender (OR 2.88 [1.52-5.47] P=< 0.001) was significantly associated with increased risk of no follow up. Conclusion: Younger males without insurance and with longer driving time and distance to the hospital are more likely to not have surveillance colonoscopy after resection of high-risk colonic polyps. Understanding the patient population who is lost in follow up is key for the implementation of targeted quality improvement interventions.Table 1.: Patient characteristics by type of follow up after index colonoscopy.