title: A statewide colectomy experience: the role of full bowel preparation in preventing surgical site infection.
abstract: OBJECTIVE
  To assess the utility of full bowel preparation with oral nonabsorbable antibiotics in preventing infectious complications after elective colectomy.
  
  
  BACKGROUND
  Bowel preparation before elective colectomy remains controversial. We hypothesize that mechanical bowel preparation with nonabsorbable oral antibiotics is associated with a decreased rate of postoperative infectious complications when compared with no bowel preparation.
  
  
  METHODS
  Patient and clinical data were obtained from the Michigan Surgical Quality Collaborative-Colectomy Best Practices Project. Propensity score analysis was used to match elective colectomy cases based on primary exposure variable-full bowel preparation (mechanical bowel preparation with nonabsorbable oral antibiotics) or no bowel preparation (neither mechanical bowel preparation given nor nonabsorbable oral antibiotic given). The primary outcomes for this study were occurrence of surgical site infection and Clostridium difficile colitis.
  
  
  RESULTS
  In total, 2475 cases met the study criteria. Propensity analysis created 957 paired cases (n = 1914) differing only by the type of bowel preparation. Patients receiving full preparation were less likely to have any surgical site infection (5.0% vs 9.7%; P = 0.0001), organ space infection (1.6% vs 3.1%; P = 0.024), and superficial surgical site infection (3.0% vs 6.0%; P = 0.001). Patients receiving full preparation were also less likely to develop postoperative C difficile colitis (0.5% vs 1.8%, P = 0.01).
  
  
  CONCLUSIONS
  In the state of Michigan, full bowel preparation is associated with decreased infectious complications after elective colectomy. Within this context, the Michigan Surgical Quality Collaborative recommends full bowel preparation before elective colectomy.
authors: From the Department of Surgery, University of Michigan, Ann Arbor, MI.
authors: Edward K
authors: EK
authors: Kim
authors: Kyle H
authors: KH
authors: Sheetz
authors: Julie
authors: J
authors: Bonn
authors: Scott
authors: S
authors: DeRoo
authors: Christopher
authors: C
authors: Lee
authors: Isaac
authors: I
authors: Stein
authors: Arya
authors: A
authors: Zarinsefat
authors: Shijie
authors: S
authors: Cai
authors: Darrell A
authors: DA
authors: Campbell
authors: Michael J
authors: MJ
authors: Englesbe
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002400:Cathartics; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D003082:Colectomy; D003092:Colitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D008824:Michigan; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D002400:Cathartics