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The role of mechanical bowel preparation and oral antibiotics for left-sided laparoscopic and open elective restorative colorectal surgery with and without faecal diversion

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Abstract

Background

There is significant variation in the use of mechanical bowel preparation and oral antibiotics prior to left-sided elective colorectal surgery. There has been no consensus internationally.

Methods

This was a retrospective analysis of the 2015 American College of Surgeons National Surgical Quality Improvement Program database. Patients were divided into four groups: those who had mechanical bowel preparation with oral antibiotics, mechanical bowel preparation alone, oral antibiotics alone and no preparation. The main outcome measures included overall, superficial, deep and organ/space surgical site infections. Secondary outcomes included anastomotic leak, ileus and rate of Clostridium difficile.

Results

A total of 5729 patients were included for analysis. The overall surgical site infection rate (any superficial, deep or organ/space infection) was significantly lower in the mechanical bowel preparation and oral antibiotics approach when compared to no preparation (OR = 0.46, 95% CI 0.36–0.59, P < 0.0001). On multivariable logistic regression analysis, mechanical bowel preparation with oral antibiotics maintained a lower risk of overall surgical site infections. MBP and OAB also had a protective effect on anastomotic leak in both the laparoscopic and open cohorts (laparoscopic multivariable adjusted OR = 0.42 (0.19–0.94), P = 0.035; open multivariable adjusted OR = 0.3 (0.12–0.77), P = 0.012). Mechanical bowel preparation alone and oral antibiotics alone was not associated with a significant decrease in surgical site infections. There was no increase in C. difficile occurrences with the use of oral antibiotics.

Conclusion

Mechanical bowel preparation with oral antibiotics significantly minimised surgical site infections and anastomotic leak following both laparoscopic and open left-sided restorative colorectal surgery. Mechanical bowel preparation alone did not reduce surgical site infections. There was a trend to reduction in surgical site infections with oral antibiotics alone.

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Authors and Affiliations

  1. Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia

    James Wei Tatt Toh, Kevin Phan, Grahame Ctercteko, Nimalan Pathma-Nathan, Toufic El-Khoury, Arthur Richardson, Gary Morgan, Reuben Tang & Kerry Hitos

  2. Department of Surgery, Division of Surgery and Anaesthetics, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW, 2145, Australia

    James Wei Tatt Toh, Grahame Ctercteko, Nimalan Pathma-Nathan, Toufic El-Khoury, Arthur Richardson, Gary Morgan, Mingjuan Zeng, Susan Donovan & Kerry Hitos

  3. Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, Australia

    James Wei Tatt Toh & Kerry Hitos

  4. University of Notre Dame Australia, Sydney, Australia

    Toufic El-Khoury

  5. Division of Gastrointestinal Surgery, University of Alabama, Birmingham, AL, USA

    Daniel Chu & Gregory Kennedy

Authors
  1. James Wei Tatt Toh
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  2. Kevin Phan
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  13. Kerry Hitos
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Contributions

Dr. James Toh made substantial contributions to the design and interpretation of the study including acquisition of data, statistical analysis, drafting and revision of manuscript. Associate Professor Kerry Hitos contributed to the statistical analysis and revision of manuscript. Susan Donovan and Mingjuan Zeng contributed to the acquisition of data and revision of manuscript. Dr. Kevin Phan, Dr. Grahame Ctercteko, Dr. Nimalan Pathma-Nathan, Dr. Toufic El-Khoury, Associate Professor Arthur Richardson, Associate Professor Gary Morgan, Dr. Reuben Tang, Dr. Dan Chu and Associate Professor Greg Kennedy contributed to the drafting and revision of manuscript. Final approval of the version to be published was made by all authors.

Corresponding author

Correspondence to James Wei Tatt Toh.

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Toh, J.W.T., Phan, K., Ctercteko, G. et al. The role of mechanical bowel preparation and oral antibiotics for left-sided laparoscopic and open elective restorative colorectal surgery with and without faecal diversion. Int J Colorectal Dis 33, 1781–1791 (2018). https://doi.org/10.1007/s00384-018-3166-8

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  • DOI: https://doi.org/10.1007/s00384-018-3166-8

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