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The effect of mechanical bowel preparation on anastomotic leaks in elective left-sided colorectal resections
Ahmad Elnahas1, David Urbach1, Gerald Lebovic2
1Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
Background:
Routine preoperative mechanical bowel preparation (MBP) for left-sided colorectal resections remains controversial. This study aims to evaluate the association between MBP and 30-day anastomotic leaks.
Methods:
A retrospective cohort study was conducted using data from the National Surgical Quality Improvement Program from 2011 to 2012. Multiple imputation was used for missing data, and a multivariable logistic regression was performed to adjust for clinically relevant variables. A propensity score-adjusted model was performed as a sensitivity analysis.
Results:
A total of 2,581 patients (57%) received preoperative MBP, whereas 1,935 (43%) did not. The 30-day anastomotic leak rate with and without preoperative MBP was 3.1% and 5.1%, respectively. After covariate adjustment, MBP omission was significantly associated with a 40% increased odds of 30-day anastomotic leaks (odds ratio 1.41, P = .04, 95% confidence interval 1.01 to 1.93).
Conclusions:
MBP omission was associated with a higher rate of 30-day anastomotic leaks. A large, well-designed, randomized controlled trial is needed to further evaluate this relationship.
Insights
Omitting preoperative mechanical bowel preparation (MBP) for left-sided colorectal surgery was linked to a higher risk of anastomotic leaks within 30 days. Further research is recommended to confirm these findings.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Gastroenterology
Background:
- Mechanical bowel preparation (MBP) before left-sided colorectal surgery is a debated practice.
- The association between MBP and postoperative anastomotic leaks requires further investigation.
Purpose of the Study:
- To evaluate the relationship between preoperative mechanical bowel preparation (MBP) and 30-day anastomotic leaks in patients undergoing left-sided colorectal resections.
Main Methods:
- Retrospective cohort study utilizing the National Surgical Quality Improvement Program database (2011-2012).
- Multivariable logistic regression and propensity score-adjusted analysis were employed to control for confounding variables.
- Multiple imputation was used to handle missing data.
Main Results:
- 2,581 patients (57%) received preoperative MBP, while 1,935 (43%) did not.
- The 30-day anastomotic leak rates were 3.1% for patients with MBP and 5.1% for those without.
- MBP omission was significantly associated with a 40% increased odds of 30-day anastomotic leaks (OR 1.41, P = .04).
Conclusions:
- Omission of preoperative mechanical bowel preparation is linked to an increased rate of 30-day anastomotic leaks.
- A large, well-designed randomized controlled trial is necessary to definitively establish the role of MBP in preventing anastomotic leaks.
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