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Most Patients Undergoing Elective Colorectal Surgery Receive Inadequate Bowel Preparation to Prevent Postoperative Complications

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Key Points

  • Patients who received oral antibiotics combined with mechanical bowel preparation were half as likely to develop a postoperative surgical site infection compared to patients who received no preparation or mechanical bowel preparation alone.
  • Patients who received the combination regimen also had lower rates of return to the operating room and readmission, and had shorter overall hospital stays.
  • The study also suggests that oral antibiotics alone may be equally effective, whereas mechanical bowel preparation alone (used in more than one-third of the patients in the study) was no more effective than no bowel preparation.

In the largest study of its kind to date, researchers from Fox Chase Cancer Center and the Lewis Katz School of Medicine at Temple University confirmed that oral antibiotics combined with mechanical bowel preparation were more effective at preventing surgical site infections after elective colorectal surgery compared to no bowel preparation or use of mechanical bowel preparation alone. Of note, more than half of patients who undergo elective colorectal surgery in the United States receive either no bowel preparation or mechanical bowel preparation alone. Nestor F. Esnaola, MD, MPH, Professor of Surgical Oncology at Fox Chase, led the study, which was published by Koller et al in Annals of Surgery.

Surgical site infections are the most common type of hospital-acquired infection, affecting nearly 160,000 people every year, and costing an estimated $13,000 per infection. Every year surgeons perform tens of thousands of elective colorectal resections in the United States. The procedure is associated with particularly high rates of surgical site infection; surgeons can use a variety of approaches, including bowel preparation, to potentially reduce this risk.

Using the American College of Surgeons National Surgery Quality Improvement Program database, the research team analyzed data from more than 30,000 patients who underwent elective colorectal resections from 2012 to 2014. They studied patients who received no bowel preparation, mechanical bowel preparation alone, oral antibiotics alone, or the two combined.

Study Findings

Although there is ongoing debate within the surgical community regarding which, if any, method is most effective, the study provides compelling evidence that patients who receive oral antibiotics combined with mechanical bowel preparation are half as likely to develop a postoperative surgical site infection compared to patients who receive no preparation or mechanical bowel preparation alone. Patients who received the combination regimen also had lower rates of return to the operating room and readmission, and had shorter overall hospital stays. The study also suggests that oral antibiotics alone may be equally effective, whereas mechanical bowel preparation alone—which was used in more than a third of the patients in the study—is no more effective than no bowel preparation.

Of importance, the team noted that the combination regimen did not show higher rates of various adverse events often cited as reasons not to use these regimens, such as cardiac or renal complications, slower return of bowel function, or bowel leak.

“Our study shows that mechanical bowel preparation alone prior to this surgery is ineffective and should be abandoned,” said Dr. Esnaola. “The combination of oral antibiotics and mechanical bowel preparation is an effective tool to safely reduce surgical site infections, complications, and readmission after elective colorectal surgery. We should deploy this strategy whenever possible to protect our patients.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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