Combined Mechanical and Oral Antibiotic Bowel Preparation Reduces Incisional Surgical Site Infection and Anastomotic Leak Rates After Elective Colorectal Resection

TLDR

The study aimed to assess how preoperative bowel preparation influences 30‑day outcomes following elective colorectal resection. Using the 2012 ACS NSQIP database, 4,999 patients were categorized into combined mechanical and oral antibiotic, mechanical only, oral antibiotic only, or no preparation groups, and multivariate regression adjusted for patient and procedure variables evaluated the association with postoperative outcomes. Patients receiving combined mechanical and oral antibiotic preparation experienced significantly lower 30‑day incisional surgical site infection (3.2% vs 9.0%), anastomotic leak (2.8% vs 5.7%), and readmission (5.5% vs 8.0%) rates compared with those receiving no preparation, while mechanical or oral antibiotic alone did not differ from no preparation.

Abstract

In Brief Objective: To determine the association between preoperative bowel preparation and 30-day outcomes after elective colorectal resection. Methods: Patients from the 2012 Colectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database who underwent elective colorectal resection were included for analysis and assigned to 1 of 4 groups based on the type of preoperative preparation they received [combined mechanical and oral antibiotic preparation (OAP), mechanical preparation only, OAP only, or no preoperative bowel preparation]. The association between preoperative bowel preparation status and 30-day postoperative outcomes was assessed using multivariate regression analysis to adjust for a robust array of patient- and procedure-related factors. Results: A total of 4999 patients were included for this study [1494 received (29.9%) combined mechanical and OAP, 2322 (46.5%) received mechanical preparation only, 91 (1.8%) received OAP only, and 1092 (21.8%) received no preoperative preparation]. Compared to patients receiving no preoperative preparation, patients who received combined preparation demonstrated a lower 30-day incidence of postoperative incisional surgical site infection (3.2% vs 9.0%, P < 0.001), anastomotic leakage (2.8% vs 5.7%, P = 0.001), and procedure-related hospital readmission (5.5% vs 8.0%, P = 0.03). The outcomes of patients who received either mechanical or OAP alone did not differ significantly from those who received no preparation. Conclusions: Combined bowel preparation with mechanical cleansing and oral antibiotics results in a significantly lower incidence of incisional surgical site infection, anastomotic leakage, and hospital readmission when compared to no preoperative bowel preparation. Our analysis of 4099 patients from the 2012 Colectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program database demonstrates that patients who receive both mechanical and oral antibiotic bowel preparations before elective colorectal resection experience significantly lower rates of postoperative incisional surgical site infection and anastomotic leakage when compared with patients who receive no preparation.