Prospective, randomized trial of inpatient vs. outpatient bowel preparation for elective colorectal surgery.
A prospective, randomized trial of inpatient vs. outpatient bowel preparation for elective colorectal surgery was performed in 100 consecutive patients. Bowel preparation was standardized for both groups and consisted of 4 liters of Colyte (Reed & Carnrick, Piscataway, NJ) and oral neomycin and Flagyl (G. D. Searle & Co., Skokie, IL) the day before surgery. Patients were randomized into four subcategories: ileocolostomy, colocolostomy, abdominal perineal resection, and other. Tap water enemas were administered on the morning of surgery to ensure and adequate mechanical preparation. Ninety-six percent of the inpatient group and 97 percent of the outpatient group were able to drink three-fourths or more of the oral lavage preparation (P = 0.789, Fisher's exact text). A mean of 2.26 tap water enemas was required to achieve clear returns for the inpatient group, compared with 2.28 tap water enemas for the outpatient group (P = 0.221, Fisher's exact test). The adequacy of the bowel preparation as graded by the primary surgeon was good (84 percent), fair (12 percent), and poor (4 percent) in the outpatient group (P = 0.673, Fisher's exact test). Wound infection developed in 4 percent of the inpatient group and 4 percent of the outpatient group (P = 1.0, Fisher's exact test). Anastomotic leak of intra-abdominal abscess was seen in one patient in each group (P = 1.0, Fisher's exact test). We conclude that outpatient bowel preparation is as effective as inpatient bowel preparation for elective colorectal surgery and offers the advantage of cost savings and shorter hospitalization.
Frazee
R C
RC
Scott & White Clinic, Temple, Texas 76508.
Roberts
J
J
Symmonds
R
R
Snyder
S
S
Hendricks
J
J
Smith
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D003106:Colon / Q000601:surgery*; D004032:Diet; D004573:Electrolytes; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D009355:Neomycin / Q000008:administration & dosage; D011092:Polyethylene Glycols; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D007507:Therapeutic Irrigation
D004573:Electrolytes; C033608:Golytely; D008795:Metronidazole; D011092:Polyethylene Glycols; D009355:Neomycin