title: Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery.
abstract: OBJECTIVE
  To clarify whether bowel preparation use or its individual components [mechanical bowel preparation (MBP)/oral antibiotics] impact specific outcomes after colorectal surgery.
  
  
  METHODS
  National Surgical Quality Improvement Program-targeted colectomy data initiated in 2012 capture information on the use/type of bowel preparation and colorectal-specific complications. For patients undergoing elective colorectal resection, the impact of preoperative MBP and antibiotics (MBP+/ABX+), MBP alone (MBP+/ABX-), and no bowel preparation (no-prep) on outcomes, particularly anastomotic leak, surgical site infection (SSI), and ileus, were evaluated using unadjusted/adjusted logistic regression analysis.
  
  
  RESULTS
  Of 8442 patients, 2296 (27.2%) had no-prep, 3822 (45.3%) MBP+/ABX-, and 2324 (27.5%) MBP+/ABX+. Baseline characteristics were similar; however, there were marginally more patients with prior sepsis, ascites, steroid use, bleeding disorders, and disseminated cancer in no-prep. MBP with or without antibiotics was associated with reduced ileus [MBP+/ABX+: odds ratio (OR) = 0.57, 95% confidence interval (CI): 0.48-0.68; MBP+/ABX-: OR = 0.78, 95% CI: 0.68-0.91] and SSI [MBP+/ABX+: OR = 0.39, 95% CI: 0.32-0.48; MBP+/ABX-: OR = 0.80, 95% CI: 0.69-0.93] versus no-prep. MBP+/ABX+ was also associated with lower anastomotic leak rate than no-prep [OR = 0.45 (95% CI: 0.32-0.64)]. On multivariable analysis, MBP with antibiotics, but not without, was independently associated with reduced anastomotic leak (OR = 0.57, 95% CI: 0.35-0.94), SSI (OR = 0.40, 95% CI: 0.31-0.53), and postoperative ileus (OR = 0.71, 95% CI: 0.56-0.90).
  
  
  CONCLUSIONS
  These data clarify the near 50-year debate whether bowel preparation improves outcomes after colorectal resection. MBP with oral antibiotics reduces by nearly half, SSI, anastomotic leak, and ileus, the most common and troublesome complications after colorectal surgery.
authors.affiliation: *Division of Colorectal Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY; and †Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Ravi Pokala
authors.initials: RP
authors.lastname: Kiran
authors.forename: Alice C A
authors.initials: AC
authors.lastname: Murray
authors.forename: Cody
authors.initials: C
authors.lastname: Chiuzan
authors.forename: David
authors.initials: D
authors.lastname: Estrada
authors.forename: Kenneth
authors.initials: K
authors.lastname: Forde
mesh_terms: D000284:Administration, Oral; D000368:Aged; D057868:Anastomotic Leak / Q000517:prevention & control*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002400:Cathartics / Q000008:administration & dosage; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D045823:Ileus / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002400:Cathartics