title: The effect of mechanical bowel preparation on anastomotic leaks in elective left-sided colorectal resections.
abstract: BACKGROUND
  Routine preoperative mechanical bowel preparation (MBP) for left-sided colorectal resections remains controversial. This study aims to evaluate the association between MBP and 30-day anastomotic leaks.
  
  
  METHODS
  A retrospective cohort study was conducted using data from the National Surgical Quality Improvement Program from 2011 to 2012. Multiple imputation was used for missing data, and a multivariable logistic regression was performed to adjust for clinically relevant variables. A propensity score-adjusted model was performed as a sensitivity analysis.
  
  
  RESULTS
  A total of 2,581 patients (57%) received preoperative MBP, whereas 1,935 (43%) did not. The 30-day anastomotic leak rate with and without preoperative MBP was 3.1% and 5.1%, respectively. After covariate adjustment, MBP omission was significantly associated with a 40% increased odds of 30-day anastomotic leaks (odds ratio 1.41, P = .04, 95% confidence interval 1.01 to 1.93).
  
  
  CONCLUSIONS
  MBP omission was associated with a higher rate of 30-day anastomotic leaks. A large, well-designed, randomized controlled trial is needed to further evaluate this relationship.
authors.affiliation: Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Elnahas
authors.affiliation: Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Urbach
authors.affiliation: Applied Health Research Centre, Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Gerald
authors.initials: G
authors.lastname: Lebovic
authors.affiliation: Applied Health Research Centre, Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.affiliation: Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.affiliation: Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: Fayez A
authors.initials: FA
authors.lastname: Quereshy
authors.affiliation: Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada. Electronic address: timothy.jackson@uhn.ca.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology*; D000970:Antineoplastic Agents / Q000009:adverse effects; D015331:Cohort Studies; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D057216:Propensity Score; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas; D013530:Surgical Wound Infection / Q000517:prevention & control; D007507:Therapeutic Irrigation / Q000009:adverse effects* / Q000379:methods
chemical_list: D000970:Antineoplastic Agents; D005938:Glucocorticoids
keywords: Anastomotic leaks; Bowel preparation; Colorectal surgery