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Combined Preoperative Mechanical Bowel Preparation With Oral Antibiotics Significantly Reduces Surgical Site Infection, Anastomotic Leak, and Ileus After Colorectal Surgery

Kiran, Ravi Pokala MBBS, MS, FRCS, FACS, MSc (EBM), FASCRS*,†; Murray, Alice C. A. BSc, MBBS, MRCS*; Chiuzan, Cody PhD; Estrada, David MD*; Forde, Kenneth MD*

doi: 10.1097/SLA.0000000000001416
Papers of the 135th ASA Annual Meeting

Objectives: To clarify whether bowel preparation use or its individual components [mechanical bowel preparation (MBP)/oral antibiotics] impact specific outcomes after colorectal surgery.

Methods: National Surgical Quality Improvement Program–targeted colectomy data initiated in 2012 capture information on the use/type of bowel preparation and colorectal-specific complications. For patients undergoing elective colorectal resection, the impact of preoperative MBP and antibiotics (MBP+/ABX+), MBP alone (MBP+/ABX−), and no bowel preparation (no-prep) on outcomes, particularly anastomotic leak, surgical site infection (SSI), and ileus, were evaluated using unadjusted/adjusted logistic regression analysis.

Results: Of 8442 patients, 2296 (27.2%) had no-prep, 3822 (45.3%) MBP+/ABX−, and 2324 (27.5%) MBP+/ABX+. Baseline characteristics were similar; however, there were marginally more patients with prior sepsis, ascites, steroid use, bleeding disorders, and disseminated cancer in no-prep. MBP with or without antibiotics was associated with reduced ileus [MBP+/ABX+: odds ratio (OR) = 0.57, 95% confidence interval (CI): 0.48–0.68; MBP+/ABX−: OR = 0.78, 95% CI: 0.68–0.91] and SSI [MBP+/ABX+: OR = 0.39, 95% CI: 0.32–0.48; MBP+/ABX−: OR = 0.80, 95% CI: 0.69–0.93] versus no-prep. MBP+/ABX+ was also associated with lower anastomotic leak rate than no-prep [OR = 0.45 (95% CI: 0.32–0.64)]. On multivariable analysis, MBP with antibiotics, but not without, was independently associated with reduced anastomotic leak (OR = 0.57, 95% CI: 0.35–0.94), SSI (OR = 0.40, 95% CI: 0.31–0.53), and postoperative ileus (OR = 0.71, 95% CI: 0.56–0.90).

Conclusions: These data clarify the near 50-year debate whether bowel preparation improves outcomes after colorectal resection. MBP with oral antibiotics reduces by nearly half, SSI, anastomotic leak, and ileus, the most common and troublesome complications after colorectal surgery.

National Surgical Quality Improvement Program–targeted colectomy data initiated in 2012 were queried for all patients undergoing elective colorectal resection. Results show that mechanical bowel preparation with oral antibiotics independently reduces the odds of postoperative colorectal-specific adverse outcomes including surgical site infection, anastomotic leak, and ileus, the most common and troublesome complications after colorectal surgery.

*Division of Colorectal Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY; and

Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.

Reprints: Ravi Pokala Kiran, MBBS, MS, FRCS, FACS, MSc (EBM), FASCRS, Division of Colorectal Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor 8, New York, NY 10032. E-mail: rpk2118@cumc.columbia.edu.

Presented at the 135th Annual Meeting of the American Surgical Association, April 23–25, 2015, San Diego, CA.

Disclosure: This manuscript has been seen and approved by all authors. The authors declare no conflicts of interest.

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