Comparative Effectiveness and Risks of Bowel Preparation Before Elective Colorectal Surgery

Area of Science:

• Colorectal Surgery
• Surgical Site Infections
• Patient Outcomes

Background:

• Surgical site infections (SSIs) are a significant cause of morbidity and cost following colorectal surgery.
• The effectiveness of preoperative bowel preparation in preventing SSIs remains a subject of debate.

Purpose of the Study:

• To investigate the association between different types of bowel preparation and the incidence of SSIs and other postoperative complications after elective colorectal surgery.

Main Methods:

• Analysis of 32,359 patients undergoing elective colorectal resections from the American College of Surgeons National Surgery Quality Improvement Program database (2012-2014).
• Utilized univariable, multivariable, and propensity adjustment analyses to evaluate the impact of bowel preparation on outcomes.

Main Results:

• Mechanical bowel preparation (MBP) alone showed no reduction in SSI risk compared to no preparation.
• Oral antibiotics (OA) and MBP+OA were associated with significantly decreased risks of SSI (aOR 0.49 and 0.45, respectively).
• OA and MBP+OA also reduced risks of anastomotic leak, ileus, readmission, and length of stay, without increasing cardiac/renal complications.

Conclusions:

• Mechanical bowel preparation (MBP) alone is ineffective for preventing SSIs and should be discontinued.
• Oral antibiotics (OA), alone or in combination with MBP, effectively reduce SSIs and other adverse outcomes.
• Routine use of MBP+OA is recommended for preventing SSIs in elective colorectal surgery, pending further studies on OA efficacy.