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Oral Antibiotic Bowel Preparation Prior to Urgent Colectomy Reduces Odds of Organ Space Surgical Site Infections: a NSQIP Propensity-Score Matched Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Preoperative administration of oral antibiotic bowel preparation (OABP) alone has been shown to reduce infectious outcomes in patients undergoing elective colectomy. However, it remains unclear if these benefits extend to the emergency setting. This is a retrospective, propensity-score matched study comparing 30-day perioperative morbidity between those who received OABP alone versus no preparation prior to urgent colectomy.

Methods

Using the American College of Surgeons National Surgical Quality Improvement Program database, adults undergoing urgent colectomy from 2012 to 2019 were included. Those who were clinically obstructed or who received mechanical bowel preparation were excluded. Outcomes of interest included: surgical site infection (SSI), leak, ileus, and major morbidity.

Results

Of 24,559 patients meeting inclusion criteria, 878 (3.6%) received OABP prior to urgent colectomy. Prior to matching, those receiving no preparation were more likely to have higher ASA class, diabetes, hypertension, preoperative sepsis, open procedures, and a dirty wound classification. After matching, 1756 patients, remained with 878 in each arm. Preoperative characteristics were balanced on univariate analysis. Postoperatively, patients receiving OABP experienced decreased organ space SSI (11.2% vs. 15.5%, p = 0.009) and ileus (30.3% vs. 35.3%, p = 0.029), with no difference in leak rates (3.3% vs 3.3%, p = 1.000) or NSQIP major morbidity (47.4% vs. 49.9%, p = 0.316). On multivariate logistic regression, including propensity score, the reduction in organ space SSI associated with OABP persisted (OR 0.684, 95% CI 0.516–0.903).

Conclusion

OABP prior to select urgent colectomies was associated with fewer organ space SSIs and may be considered when feasible.

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References

  1. Fry DE. Colon preparation and surgical site infection. Am J Surg. 2011;202(2):225-232.

    Article  Google Scholar 

  2. Nichols RL, Condon RE, Gorbach SL, Nyhus LM. Efficacy of preoperative antimicrobial preparation of the bowel. Ann Surg. 1972;176(2):227-232.

    Article  CAS  Google Scholar 

  3. Jung B, Matthiessen P, Smedh K, Nilsson E, Ransjo U, Pahlman L. Mechanical bowel preparation does not affect the intramucosal bacterial colony count. Int J Colorectal Dis. 2010;25(4):439-442.

    Article  Google Scholar 

  4. Rollins KE, Javanmard-Emamghissi H, Lobo DN. Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis. World J Gastroenterol. 2018;24(4):519-536.

    Article  Google Scholar 

  5. Guenaga KF, Matos D, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2011(9):CD001544.

  6. Toh JWT, Phan K, Hitos K, et al. Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection: a network meta-analysis. JAMA Netw Open. 2018;1(6):e183226.

    Article  Google Scholar 

  7. McSorley ST, Steele CW, McMahon AJ. Meta-analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgical-site infections in elective colorectal surgery. BJS Open. 2018;2(4):185-194.

    Article  CAS  Google Scholar 

  8. European Society of Coloproctology collaborating g. Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit. Colorectal Dis. 2018;20 Suppl 6:15–32.

  9. Hata H, Yamaguchi T, Hasegawa S, et al. Oral and parenteral versus parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery (JMTO PREV 07-01): a phase 3, multicenter, open-label, randomized trial. Ann Surg. 2016;263(6):1085-1091.

    Article  Google Scholar 

  10. Sadahiro S, Suzuki T, Tanaka A, et al. Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: prospective randomized trial. Surgery. 2014;155(3):493-503.

    Article  Google Scholar 

  11. Oshima T, Takesue Y, Ikeuchi H, et al. Preoperative oral antibiotics and intravenous antimicrobial prophylaxis reduce the incidence of surgical site infections in patients with ulcerative colitis undergoing IPAA. Dis Colon Rectum. 2013;56(10):1149-1155.

    Article  Google Scholar 

  12. Migaly J, Bafford AC, Francone TD, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the use of bowel preparation in elective colon and rectal surgery. Dis Colon Rectum. 2019;62(1):3-8.

    Article  Google Scholar 

  13. Garfinkle R, Abou-Khalil J, Morin N, et al. Is there a role for oral antibiotic preparation alone before colorectal surgery? ACS-NSQIP analysis by coarsened exact matching. Dis Colon Rectum. 2017;60(7):729-737.

    Article  Google Scholar 

  14. Morris MS, Graham LA, Chu DI, Cannon JA, Hawn MT. Oral antibiotic bowel preparation significantly reduces surgical site infection rates and readmission rates in elective colorectal surgery. Ann Surg. 2015;261(6):1034-1040.

    Article  Google Scholar 

  15. Adeli K, Raizman JE, Chen Y, et al. Complex biological profile of hematologic markers across pediatric, adult, and geriatric ages: establishment of robust pediatric and adult reference intervals on the basis of the Canadian Health Measures Survey. Clin Chem. 2015;61(8):1075-1086.

    Article  CAS  Google Scholar 

  16. Ho D, Imai K, King G, Stuart EA MatchIt: nonparametric preprocessing for parametric causal inference. 2011. 2011;42(8):28.

  17. Nichols RL, Condon RE, DiSanto AR. Preoperative bowel preparation. Erythromycin base serum and fecal levels following oral administration. Arch Surg. 1977;112(12):1493-1496.

    Article  CAS  Google Scholar 

  18. Roos D, Dijksman LM, Tijssen JG, Gouma DJ, Gerhards MF, Oudemans-van Straaten HM. Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery. Br J Surg. 2013;100(12):1579-1588.

    Article  CAS  Google Scholar 

  19. Koskenvuo L, Lehtonen T, Koskensalo S, et al. Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial. The Lancet. 2019;394(10201):840-848.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, McGill University, Montreal, QC, Canada

    Ebram Salama, Faisal Al-Rashid, Allison Pang, Gabriela Ghitulescu, Carol-Ann Vasilevsky & Marylise Boutros

  2. Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine, Room G-308, Montreal, QC, H3T 1E2, Canada

    Marylise Boutros

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  1. Ebram Salama
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  2. Faisal Al-Rashid
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  3. Allison Pang
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  4. Gabriela Ghitulescu
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  5. Carol-Ann Vasilevsky
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Contributions

All authors contributed to the design of the study. ES, FA, and MB participated in data acquisition. ES, FA, AP, GG, CV, and MB participated in data analysis and interpretation. ES and MB prepared the first draft of the manuscript. All authors contributed to, and approved, the final version of the manuscript.

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Correspondence to Marylise Boutros.

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Salama, E., Al-Rashid, F., Pang, A. et al. Oral Antibiotic Bowel Preparation Prior to Urgent Colectomy Reduces Odds of Organ Space Surgical Site Infections: a NSQIP Propensity-Score Matched Study. J Gastrointest Surg 26, 2193–2200 (2022). https://doi.org/10.1007/s11605-022-05440-8

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  • DOI: https://doi.org/10.1007/s11605-022-05440-8

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