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Mechanical bowel prep insufficient for preventing complications after elective colorectal surgery
Mechanical bowel preparation alone was inferior to oral antibiotics and a combination of mechanical bowel preparation and oral antibiotics for preventing surgical site infection and other complications after elective colorectal surgery, according to retrospective study data.
As more than half of patients received mechanical bowel preparation alone or no bowel preparation before their surgery, study investigators emphasized the need for abandoning these strategies.
“Our study shows that mechanical bowel preparation alone prior to this surgery is ineffective and should be abandoned,” Nestor F. Esnaola, MD, MPH, professor of surgical oncology at Fox Chase Cancer Center in Philadelphia, said in a press release. “The combination of oral antibiotics and mechanical bowel preparation is an effective tool to safely reduce surgical site infections, complications, and readmission after elective colorectal surgery. We should deploy this strategy whenever possible to protect our patients.”
Esnaola and colleagues identified 32,359 patients (mean age, 60.9 years; 51.7% women; 79.3% white) within the American College of Surgeons National Surgery Quality Improvement Program database who underwent elective colorectal resection between 2012 and 2014, and evaluated the associations between bowel preparation strategies and postoperative outcomes.
Overall, 26.7% of patients received no bowel preparation, 36.6% received mechanical bowel preparation only, 3.8% received oral antibiotics only and 32.9% received a combination of mechanical bowel preparation and oral antibiotics. Further, 9% developed a surgical site infection (SSI).
After adjusting for patient and procedural characteristics, the investigators found that mechanical bowel preparation alone was not associated with a reduced risk for SSI compared with no bowel preparation.
Conversely, oral antibiotics alone (OR = 0.49; 95% CI, 0.38-0.64) and a combination of mechanical bowel preparation and oral antibiotics (OR = 0.45; 95% CI, 0.4-0.5) were both associated with a reduced risk for SSI compared with no bowel preparation.
Additionally, both of these strategies were associated with lower risks for anastomotic leak (P = .001 and P < .001, respectively), postoperative ileus (P = .01 and P < .001, respectively), hospital readmission (P = .01 for both) and shorter length of hospital stay (P < .001 for both).
The investigators observed no significant associations between different bowel preparation strategies and cardiac or renal complications.
“Although numerous studies have demonstrated the benefits of using preoperative [oral antibiotics] in combination with [mechanical bowel preparation], use of [oral antibiotics] by surgeons has declined from 86% in 1997 to 36% in 2010,” the investigators noted.
They concluded that mechanical bowel preparation plus oral antibiotics should be routinely used before elective colorectal resection until prospective randomized trials fully evaluate the use of oral antibiotics alone in this setting. – by Adam Leitenberger
Disclosures: Esnaola reports he has received honoraria from Merck and Celgene, and another researcher reports he has received honoraria from Intuitive Surgical.