title: Variation in bowel preparation among pediatric surgeons for elective colorectal surgery: A problem of equipoise or a knowledge gap of the available clinical evidence?
abstract: OBJECTIVE
  Despite rigorous data from adult literature demonstrating that oral antibiotics (OA) reduce infectious complications and mechanical bowel preparation (MBP) alone does not, MBP alone remains the preferred approach among pediatric surgeons. We aimed to explore the nature of this discrepancy through a survey of the American Pediatric Surgical Association membership.
  
  
  METHODS
  Surgeons were queried for their choice of bowel preparation, factors influencing their practice, and their impression of the strength and relevance of the adult literature to pediatric practice.
  
  
  RESULTS
  Surgeons who used MBP alone (31%) cited a reduction in stool burden and infectious complications as important factors, whereas surgeons choosing not to use OA (70%) reported a lack of benefit in reducing infectious complications as the primary reason. Although 53% of surgeons reported that evidence from adult literature was the most important influence, 73% of surgeons reported there was poor evidence supporting the use of OA (±MBP), and only 25% used a preparation supported by adult randomized data.
  
  
  CONCLUSIONS
  Wide variation exists among pediatric surgeons in the perceived utility of MBP and OA. Although the majority of pediatric surgeons cited the adult literature as the strongest influence on their practice, this is not consistent with stated perceptions or practice.
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Christina
authors.initials: C
authors.lastname: Feng
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Feroze
authors.initials: F
authors.lastname: Sidhwa
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Seema
authors.initials: S
authors.lastname: Anandalwar
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Elliot C
authors.initials: EC
authors.lastname: Pennington
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Sonja
authors.initials: S
authors.lastname: Ziniel
authors.affiliation: University of Florida College of Medicine, Gainesville, FL.
authors.forename: Saleem
authors.initials: S
authors.lastname: Islam
authors.affiliation: Children's Mercy Hospitals & Clinics, Kansas City, MO.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: Seattle Children's Hospital, Seattle, WA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: Shawn.Rangel@childrens.harvard.edu.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
mesh_terms: D000284:Administration, Oral; D019072:Antibiotic Prophylaxis; D002648:Child; D003106:Colon / Q000601:surgery*; D017558:Elective Surgical Procedures; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care / Q000379:methods*; D012007:Rectum / Q000601:surgery*; D066231:Surgeons; D011795:Surveys and Questionnaires
keywords: mechanical bowel preparation; oral antibiotics; pediatric colorectal surgery