Colorectal Cancer Screening Capacity in Arizona

Background: Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death in Arizona. Given that by the year 2030 Arizona is expected to be the second most populated state in the U.S., it is imperative to evaluate whether this state has the colorectal screening capacity to accommodate the growing population.Methods: 338 members of the American College of Gastroenterology were invited to participate. Information for the total number of colonoscopies and sigmoidoscopies performed during an average week was ascertained by analyzing 105 surveys. We estimated the current and potential volume of screening procedures.Results: Physicians reported performing 8,717 endoscopic procedures weekly (7,990 colonoscopies and 727 sigmoidoscopies). They reported being able to increase their capacity by an additional 3,183 (36.5%) procedures a week (2,347 colonoscopies and 836 flexible sigmoidoscopies).Conclusions: Our findings suggest that Arizona has the ability to significantly expand its endoscopic capacity

Preoperative predictors of postoperative aspiration risk after cardiac surgery

Background: Aspiration is a common complication among hospitalized patients, and patients undergoing cardiac surgery are at increased risk. Our aim was to determine if screening for frailty could identify patients at risk for aspiration. Patients and Methods: A prospective cohort study of patients 65 and older undergoing nonemergent heart surgery at a single community hospital for 1 year was performed. All patients were screened for frailty before surgery using the 5-m walk test. All patients were screened for aspiration before and after surgery using 90-mL water swallow challenge protocol. Preoperative risk factors and postoperative outcomes were analyzed. Results: Of 166 patients studied, 16 (9.6%) were considered frail. Eleven patients (6.6%) failed the swallow screen preoperatively, and 34 patients (20.5%) failed postoperatively. Frail patients were 3.4 times more likely to fail the postoperative swallow screen than their nonfrail counterparts (odds ratio [OR] = 3.36; 95% confidence interval [CI]: 1.42–7.96; P = 0.01). After adjusting for age, comorbidities, and surgical factors, the likelihood of aspiration risk was still three times higher in frail patients (OR = 3.01; 95% CI: 1.06–8.98; P = 0.04). Conclusions: Frail patients are at increased risk of aspiration after cardiac surgery, but frailty screening does not identify all patients at risk. The 90-mL water swallow challenge is a simple and inexpensive test that can be used to identify patients at risk for aspiration