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Colorectal Cancer Screening Quality

Key findings

  • The rate of colonoscopy-related bowel perforation within 7 days of an outpatient diagnostic or therapeutic colonoscopy was 0.36 per 1,000 colonoscopies (167 perforations after 462,647 colonoscopies) in 2017. This is a decrease from 2014, when it was 0.41 per 1,000 (181 perforations after 445,687 colonoscopies).
  • The 2017 rate is well below Cancer Care Ontario’s target of less than 1 perforation per 1,000 colonoscopies.

Why is this important to Ontarians?

  • Although colonoscopy is a safe test, there is a very small risk of perforation of the colon or rectum, which may need to be fixed with surgery. A low perforation rate is a measure of high-quality care.

See Colorectal Cancer Screening Quality (Perforation) Methodology for technical information.

Report date: December 2018
Data source: Ontario Health Insurance Plan (OHIP) Claims History Database (CHDB), Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD)/National Ambulatory Care Reporting System (NACRS), Ontario Cancer Registry (OCR), Ontario Registered Persons Database (RPDB), Postal Code Conversion File Plus (PCCF+ version 6D)
Prepared by: Analytics, Cancer Screening, Prevention and Cancer Control, Cancer Care Ontario

Data Table 1: Number of outpatient colonoscopies followed by hospital admission for perforation within 7 days of procedure, per 1,000 colonoscopies, 2014 to 2017
Year Percentage (%)
2014 0.41
2015 0.37
2016 0.35
2017 0.36

Report date: December 2018
Data source: Ontario Health Insurance Plan (OHIP) Claims History Database (CHDB), Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD)/National Ambulatory Care Reporting System (NACRS), Ontario Cancer Registry (OCR), Ontario Registered Persons Database (RPDB), Postal Code Conversion File Plus (PCCF+ version 6D)
Prepared by: Analytics, Cancer Screening, Prevention and Cancer Control, Cancer Care Ontario

Results

  • The number of colonoscopy-related bowel perforations in Ontario has decreased over time.
  • In 2017, the rate of admission to hospital with a perforation within 7 days of outpatient colonoscopy was 0.36 per 1,000 colonoscopies. This represents an overall improvement in performance for this indicator compared with the 2014 rate of 0.41 per 1,000 colonoscopies.
  • Ontario’s perforation rate was well under the target of less than 1 perforation per 1,000 colonoscopies.

Comparisons

Getting comparable data and measures from other jurisdictions is a challenge. Be aware of the different data definitions, methodologies and years used in indicators measured outside of Ontario. Jurisdictional comparison is still useful to provide a rough indication of how well Ontario is doing relative to other provinces and countries.

England

In 2017, Ontario’s rate of colonoscopy-related bowel perforation within 7 days of an outpatient diagnostic or therapeutic colonoscopy was 0.36 per 1,000 colonoscopies. The English National Health Service Bowel Cancer Screening Programme reported a colonoscopy-related bowel perforation rate of 0.6 per 1,000 colonoscopies on all colonoscopies performed between August 2006 and March 2014.[1]

Be careful when comparing Ontario’s perforation rate with England’s because of the different reporting periods (2017 in Ontario versus 2006 to 2014 in England).

While the English study is the largest in Europe to describe colonoscopy perforations, it is limited by the retrospective design and some incomplete data. These colonoscopies were also all a result of a positive guaiac-based fecal occult blood test, which are higher risk procedures compared with those used in Ontario.

For more information on comparisons of colonoscopy-related bowel perforation rates among jurisdictions, see the screening graphs at Comparisons.

Opportunities

  • Minimizing harm to participants is an essential component of an organized screening program. Cancer Care Ontario will continue to monitor perforation rates as well as other colonoscopy quality indicators such as bleeding, and repeat colonoscopies within 3 years of a normal colonoscopy.
  • Annual colonoscopy quality reports are generated at the facility, regional, physician, and provincial levels. These reports highlight performance on various quality standards and indicators for colonoscopy performance, including colonoscopy-related bowel perforations. Reports are accompanied by resources to support quality improvement.

References

  1. Derbyshire, E., Hungin, P., Nickerson, C., & Rutter, M. (2018). Colonoscopic perforations in the English National Health Service Bowel Cancer Screening Programme. Endoscopy, 50(09), 861–870. doi: 10.1055/a-0584-7138