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Int J Colorectal Dis. 2018 Dec;33(12):1781-1791. doi: 10.1007/s00384-018-3166-8. Epub 2018 Sep 20.

The role of mechanical bowel preparation and oral antibiotics for left-sided laparoscopic and open elective restorative colorectal surgery with and without faecal diversion.

Author information

1
Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia. james.toh@health.nsw.gov.au.
2
Department of Surgery, Division of Surgery and Anaesthetics, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW, 2145, Australia. james.toh@health.nsw.gov.au.
3
Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, Australia. james.toh@health.nsw.gov.au.
4
Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia.
5
Department of Surgery, Division of Surgery and Anaesthetics, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW, 2145, Australia.
6
University of Notre Dame Australia, Sydney, Australia.
7
Division of Gastrointestinal Surgery, University of Alabama, Birmingham, AL, USA.
8
Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, Australia.

Abstract

BACKGROUND:

There is significant variation in the use of mechanical bowel preparation and oral antibiotics prior to left-sided elective colorectal surgery. There has been no consensus internationally.

METHODS:

This was a retrospective analysis of the 2015 American College of Surgeons National Surgical Quality Improvement Program database. Patients were divided into four groups: those who had mechanical bowel preparation with oral antibiotics, mechanical bowel preparation alone, oral antibiotics alone and no preparation. The main outcome measures included overall, superficial, deep and organ/space surgical site infections. Secondary outcomes included anastomotic leak, ileus and rate of Clostridium difficile.

RESULTS:

A total of 5729 patients were included for analysis. The overall surgical site infection rate (any superficial, deep or organ/space infection) was significantly lower in the mechanical bowel preparation and oral antibiotics approach when compared to no preparation (OR = 0.46, 95% CI 0.36-0.59, P < 0.0001). On multivariable logistic regression analysis, mechanical bowel preparation with oral antibiotics maintained a lower risk of overall surgical site infections. MBP and OAB also had a protective effect on anastomotic leak in both the laparoscopic and open cohorts (laparoscopic multivariable adjusted OR = 0.42 (0.19-0.94), P = 0.035; open multivariable adjusted OR = 0.3 (0.12-0.77), P = 0.012). Mechanical bowel preparation alone and oral antibiotics alone was not associated with a significant decrease in surgical site infections. There was no increase in C. difficile occurrences with the use of oral antibiotics.

CONCLUSION:

Mechanical bowel preparation with oral antibiotics significantly minimised surgical site infections and anastomotic leak following both laparoscopic and open left-sided restorative colorectal surgery. Mechanical bowel preparation alone did not reduce surgical site infections. There was a trend to reduction in surgical site infections with oral antibiotics alone.

KEYWORDS:

Anastomotic leak; Anterior resection; Colorectal surgery; Laparoscopic colorectal surgery; Mechanical bowel preparation; Oral antibiotics; Surgical site infections

PMID:
30238356
DOI:
10.1007/s00384-018-3166-8
[Indexed for MEDLINE]

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