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In the Absence of a Mechanical Bowel Prep, Does the Addition of Pre-Operative Oral Antibiotics to Parental
Sarah J Atkinson1,2, Brian R Swenson3, Dennis J Hanseman1,2
11 Department of Surgery, University of Cincinnati College of Medicine , Cincinnati, Ohio.
Insights
Pre-operative oral antibiotics reduce surgical site infections (SSI) after colectomy, even without mechanical bowel prep. This finding is crucial for optimizing surgical outcomes and patient safety in colectomy procedures.
Area of Science:
- Colorectal Surgery
- Surgical Infection Prevention
- Clinical Outcomes Research
Background:
- Pre-operative oral antibiotics with mechanical bowel prep (MBP) reduce surgical site infections (SSI) after colectomy.
- The necessity and safety of MBP are increasingly questioned in modern surgical practice.
- This study investigates SSI incidence without MBP, focusing on the role of oral antibiotics.
Purpose of the Study:
- To determine if pre-operative oral antibiotics reduce SSI incidence in elective colectomy patients when mechanical bowel prep is omitted.
- To evaluate the independent effect of oral antibiotics on SSI rates in this specific surgical context.
Main Methods:
- Analysis of 6,399 patients undergoing elective segmental colectomy without MBP from the 2012-2013 NSQIP database.
- Exclusion of patients who received mechanical bowel prep.
- Primary outcome: surgical site infection (SSI) within 30 days, defined by standard criteria.
Main Results:
- The incidence of SSI was 9.7% in patients receiving oral antibiotics versus 13.7% in those who did not (p=0.01).
- Multivariate analysis identified age, smoking, operative time, transfusions, oral antibiotics, and surgical approach as associated with SSI.
- After controlling for confounders, pre-operative oral antibiotics significantly decreased SSI incidence (OR=0.66, p=0.01).
Conclusions:
- Pre-operative oral antibiotics demonstrate a significant reduction in surgical site infections following elective colectomy.
- This benefit persists even when mechanical bowel prep is not utilized.
- Findings support the continued use of oral antibiotics to enhance patient safety in colectomy surgery.
Background:
Pre-operative oral antibiotics administered the day prior to elective colectomy have been shown to decrease the incidence of surgical site infections (SSI) if a mechanical bowel prep (MBP) is used. Recently, the role for mechanical bowel prep has been challenged as being unnecessary and potentially harmful. We hypothesize that if MBP is omitted, oral antibiotics do not alter the incidence of SSI following colectomy.
Methods:
We selected patients who underwent an elective segmental colectomy from the 2012 and 2013 National Surgical Quality Improvement Program colectomy procedure targeted database. Indications for surgery included colon cancer, diverticulitis, inflammatory bowel disease, or benign polyp. Patients who received mechanical bowel prep were excluded. The primary outcome measured was surgical site infection, defined as the presence of superficial, deep or, organ space infection within 30 d from surgery.
Results:
A total of 6,399 patients underwent elective segmental colectomy without MBP. The incidence of SSI differed substantially between patients who received oral antibiotics, versus those who did not (9.7% vs. 13.7%, p=0.01). Multivariate analysis indicated that age, smoking status, operative time, perioperative transfusions, oral antibiotics, and surgical approach were associated with post-operative SSI. When controlling for confounding factors, the use of pre-operative oral antibiotics decreased the incidence of surgical site infection (odds ratio=0.66, 95% confidence interval=0.48-0.90, p=0.01).
Conclusion:
Even in the absence of mechanical bowel prep, pre-operative oral antibiotics appear to reduce the incidence of surgical site infection following elective colectomy.
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