Benefits of Bowel Preparation Beyond Surgical Site Infection

Althumairi, Azah; Canner, Joseph K.; Pawlik, Timothy M.; Schneider, Eric B.; Nagarajan, Neeraja; Safar, Bashar; Efron, Jonathan E.

doi:10.1097/sla.0000000000001576

Cited by 49 publications

(33 citation statements)

References 25 publications

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“…Although the data in the present study do not permit specific reporting on preoperative dehydration or electrolyte imbalances, the addition of MBP to OABP was associated with a significant improvement in postoperative ileus (ATE −0·02) relative to OABP alone by each method of analysis, suggesting that neither dehydration nor electrolyte imbalance is a major problem. This is consistent with other reports16 demonstrating reduced odds of postoperative ileus following the addition of MBP to OABP.…”

Section: Discussionsupporting

confidence: 93%

“…Unlike earlier analyses with small numbers6 14, 16 20, the present study included 2018 patients who received OABP alone, a number sufficient to observe that addition of MBP to OABP was associated with lower odds of developing SSI, postoperative ileus, sepsis or the need for reoperation, and a reduction in postoperative LOS.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the benefits of adding MBP to OABP, it has been suggested13 16 that MBP may be associated with preoperative dehydration, electrolyte imbalances and prolonged ileus. Although the data in the present study do not permit specific reporting on preoperative dehydration or electrolyte imbalances, the addition of MBP to OABP was associated with a significant improvement in postoperative ileus (ATE −0·02) relative to OABP alone by each method of analysis, suggesting that neither dehydration nor electrolyte imbalance is a major problem.…”

Section: Discussionmentioning

confidence: 99%

“…MBP plus OABP has also been independently associated with reduced rates of anastomotic leak and postoperative ileus compared with MBP alone and with no bowel preparation5 14, 15. The reduction in SSI associated with MBP plus OABP was also associated with a reduction in wound dehiscence, pneumonia, prolonged ventilation, sepsis, septic shock, LOS, unplanned reoperations and readmissions6 7, 16.…”

Section: Introductionmentioning

confidence: 95%

“…Existing RCTs have not investigated this question, and observational studies have not answered it adequately owing to small sample sizes13 14, 16. With the 2015 release of the American College of Surgeons' National Surgical Quality Improvement Program (ACS‐NSQIP), there is now a sufficient sample size to measure the effect of MBP plus OABP on postoperative outcomes relative to OABP alone.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes following mechanical plus oral antibiotic bowel preparation versus oral antibiotics alone in patients undergoing colorectal surgery

et al. 2018

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BackgroundDespite growing evidence to support use of preoperative mechanical bowel preparation (MBP) plus oral antibiotic bowel preparation (OABP) compared with MBP alone or no bowel preparation before colorectal surgery, evidence supporting use of MBP plus OABP relative to OABP alone is lacking. This study aimed to investigate whether the addition of MBP to OABP was associated with improved clinical outcomes after colorectal surgery compared with outcomes following OABP alone.MethodsPatients who underwent colorectal surgery and preoperative bowel preparation with either OABP alone or MBP plus OABP were identified using the American College of Surgeons' National Surgical Quality Improvement Program Colectomy Targeted Participant Use Data File for 2012–2015. Thirty‐day postoperative outcomes were compared, estimating the average treatment effect with propensity score matching and inverse probability‐weighted regression adjustment.ResultsIn the final study population of 20 594 patients, 90·2 per cent received MBP plus OABP and 9·8 per cent received OABP alone. Patients who received MBP plus OABP had a lower incidence of superficial surgical‐site infection (SSI), organ space SSI, any SSI, postoperative ileus, sepsis, unplanned reoperation and mortality, and a shorter length of hospital stay (all P < 0·050). After propensity score matching and inverse probability‐weighted regression adjusted analysis, MBP plus OABP was associated with a reduction in superficial SSI, any SSI, postoperative ileus and unplanned reoperation (all P < 0·050).ConclusionsUse of MBP plus OABP before colectomy was associated with reduced SSI, postoperative ileus, sepsis and unplanned reoperations, and shorter length of hospital stay compared with OABP alone.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes following mechanical plus oral antibiotic bowel preparation versus oral antibiotics alone in patients undergoing colorectal surgery

et al. 2018

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Effects of anastomotic technique on early postoperative outcome in open right‐sided hemicolectomy

et al. 2018

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Background Despite recent improvements in colonic cancer surgery, the rate of anastomotic leakage after right hemicolectomy is still around 6–7 per cent. This study examined whether anastomotic technique (handsewn or stapled) after open right hemicolectomy for right‐sided colonic cancer influences postoperative complications. Methods Patient data from the German Society for General and Visceral Surgery (StuDoQ) registry from 2010 to 2017 were analysed. Univariable and multivariable analyses were performed. The primary endpoint was anastomotic leakage; secondary endpoints were postoperative ileus, complications and length of postoperative hospital stay (LOS). Results A total of 4062 patients who had undergone open right hemicolectomy for colonic cancer were analysed. All patients had an ileocolic anastomosis, 2742 handsewn and 1320 stapled. Baseline characteristics were similar. No significant differences were identified in anastomotic leakage, postoperative ileus, reoperation rate, surgical‐site infection, LOS or death. The stapled group had a significantly shorter duration of surgery and fewer Clavien–Dindo grade I–II complications. In multivariable logistic regression analysis, ASA grade and BMI were found to be significantly associated with postoperative complications such as anastomotic leakage, postoperative ileus and reoperation rate. Conclusion Handsewn and stapled ileocolic anastomoses for open right‐sided colonic cancer resections are equally safe. Stapler use was associated with reduced duration of surgery and significantly fewer minor complications.

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The impact of bowel preparation on the severity of anastomotic leak in colon cancer patients

et al. 2016

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Benefits of Bowel Preparation Beyond Surgical Site Infection

Abstract: Combined MBP plus OABP before elective colectomy was associated with reduced SSI, which ultimately was associated with a reduction in non-SSI-related complications.

Cited by 49 publications

References 25 publications

Clinical outcomes following mechanical plus oral antibiotic bowel preparation versus oral antibiotics alone in patients undergoing colorectal surgery

Clinical outcomes following mechanical plus oral antibiotic bowel preparation versus oral antibiotics alone in patients undergoing colorectal surgery

Effects of anastomotic technique on early postoperative outcome in open right‐sided hemicolectomy

The impact of bowel preparation on the severity of anastomotic leak in colon cancer patients

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