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A Statewide Colectomy Experience: The Role of Full Bowel Preparation in Preventing Surgical Site Infection

Kim, Edward K. BS; Sheetz, Kyle H. BS; Bonn, Julie BS; DeRoo, Scott BA; Lee, Christopher; Stein, Isaac BA; Zarinsefat, Arya BA; Cai, Shijie PhD; Campbell, Darrell A. Jr MD; Englesbe, Michael J. MD

doi: 10.1097/SLA.0b013e3182a62643
Original Articles

Objective: To assess the utility of full bowel preparation with oral nonabsorbable antibiotics in preventing infectious complications after elective colectomy.

Background: Bowel preparation before elective colectomy remains controversial. We hypothesize that mechanical bowel preparation with nonabsorbable oral antibiotics is associated with a decreased rate of postoperative infectious complications when compared with no bowel preparation.

Methods: Patient and clinical data were obtained from the Michigan Surgical Quality Collaborative–Colectomy Best Practices Project. Propensity score analysis was used to match elective colectomy cases based on primary exposure variable—full bowel preparation (mechanical bowel preparation with nonabsorbable oral antibiotics) or no bowel preparation (neither mechanical bowel preparation given nor nonabsorbable oral antibiotic given). The primary outcomes for this study were occurrence of surgical site infection and Clostridium difficile colitis.

Results: In total, 2475 cases met the study criteria. Propensity analysis created 957 paired cases (n = 1914) differing only by the type of bowel preparation. Patients receiving full preparation were less likely to have any surgical site infection (5.0% vs 9.7%; P = 0.0001), organ space infection (1.6% vs 3.1%; P = 0.024), and superficial surgical site infection (3.0% vs 6.0%; P = 0.001). Patients receiving full preparation were also less likely to develop postoperative C difficile colitis (0.5% vs 1.8%, P = 0.01).

Conclusions: In the state of Michigan, full bowel preparation is associated with decreased infectious complications after elective colectomy. Within this context, the Michigan Surgical Quality Collaborative recommends full bowel preparation before elective colectomy.

Bowel preparation before elective colectomy remains controversial. This study represents the largest to date study comparing no bowel preparation with full bowel preparation with oral nonabsorbable antibiotics. Patients receiving full bowel preparation experienced significantly fewer postoperative infectious complications than a propensity-matched cohort receiving no preoperative bowel preparation.

From the Department of Surgery, University of Michigan, Ann Arbor, MI.

Reprints: Michael J. Englesbe, MD, Department of Surgery, University of Michigan Medical School, 2926A Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109. E-mail: englesbe@med.umich.edu.

This project was completed as part of the Academic Surgeon Development Program at the University of Michigan Medical School facilitated by the Department of Surgery.

Supported by National Institutes of Health–National Institute of Diabetes and Digestive and Kidney Diseases (K08 DK0827508) to Dr Englesbe.

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.