title: The impact of bowel preparation on the severity of anastomotic leak in colon cancer patients.
abstract: OBJECTIVE
  The routine use of preoperative bowel preparation (BP) is heavily debated in the colorectal surgery literature. To date, no study has investigated the effect preoperative BP has on patients with an established anastomotic leak. We therefore seek to compare the severity of patient morbidity and mortality in patients with a known anastomotic leak based on type of preoperative BP using the Targeted Colectomy American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP).
  
  
  METHODS
  All elective colon cancer operations performed with primary anastomosis were identified within the targeted colectomy database from 2012 to 2013. Patients who experienced a postoperative anastomotic leak were identified and stratified based on preoperative BP. Variables that had an association with mechanical BP at P < 0.10 were included in a multivariate logistic regression model to determine if BP was independently associated with postoperative morbidity and mortality.
  
  
  RESULTS
  A total of 6,297 patients underwent elective colon resection with primary anastomosis for colon cancer. Two hundred and nineteen (3.5%) patients experienced an anastomotic leak. Thirty-day wound morbidity and mortality was not worse in patients who underwent preoperative BP.
  
  
  CONCLUSIONS
  BP is not associated with worse patients outcomes in those patients with an established anastomotic leak following elective colon research with primary anastomosis. J. Surg. Oncol. 2016;114:810-813. © 2016 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, The George Washington University, Washington, District of Columbia. ihaskins@gwu.edu.
authors.forename: Ivy N
authors.initials: IN
authors.lastname: Haskins
authors.affiliation: Department of Surgery, Baylor Medical Center, Dallas, Texas.
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, The George Washington University, Washington, District of Columbia.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Amdur
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, The George Washington University, Washington, District of Columbia.
authors.forename: Samir
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D003082:Colectomy; D003110:Colonic Neoplasms / Q000601:surgery*; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: anastomotic leak; bowel preparation; colectomy; colon cancer