S708 Overutilization of Inpatient Colonoscopy in Asymptomatic Anemia

Introduction: Inpatient colonoscopy is a necessary diagnostic and therapeutic procedure when performed for appropriate indications such as GI bleeding, foreign body removal, or decompression of a sigmoid volvulus. However, when performed solely to investigate unspecified anemia in patients with a negative FOBT it can be detrimental to the patient, physician, and institution. Methods: Medical records from 01/01/2023-12/31/2023 and 01/01/2024-12/31/2024 at Broward General Medical Center (BGMC) in Ft. Lauderdale, FL were screened for patients with unspecified anemia and a negative FOBT who underwent colonoscopy with anemia listed as the only indication for the procedure. Anemia was defined as Hgb less than 12.9. No other indication for colonoscopy was listed. Results: Twenty-two patients from 01/01/2023-12/31/2023 underwent colonoscopies for anemia with a negative FOBT. Twenty-six patients from 01/01/2024-12/31/2024 underwent colonoscopies for unspecified anemia with negative FOBT. Colonoscopy reports for all 48 patients found “no active bleeding.” Conclusion: All colonoscopies performed at BGMC in 2023 and 2024 in patients with unspecified anemia and a negative FOBT revealed “no active bleeding.” Inpatient preparations are notoriously poor due to delays in administering prep, decreased mobility of patients, and decreased peristalsis in the sick patient leading to repetition of these studies in the outpatient setting. Although colonoscopies are safe procedures, if an adverse event were to occur during a procedure performed for the wrong reason the physician could face medical-legal consequences. From the institutional perspective performing unnecessary inpatient procedures is costly. An inpatient colonoscopy at our institution is $1,247. Excess costs in 2023 and 2024 for inappropriate inpatient colonoscopy were $27,434 and $32,422, respectively. However, inpatient colonoscopy delays hospital discharge due to scheduling and bowel prep. The average cost of 1 additional night at our institution is $2,883. If each patient undergoing inpatient colonoscopy stayed one additional night in the hospital the excess cost in 2023 and 2024 would be $63,426 and $74,958, respectively. The total excess cost for an inpatient colonoscopy and 1 additional night in the hospital in 2023 and 2024 were $90,860 and $107,380, respectively. Patients, physicians, and medical institutions would be better served if these procedures were performed in the outpatient setting.