Mechanical bowel preparation and post-operative renal dysfunction in patients undergoing cytoreductive surgery for ovarian cancer (003)

Abstract

<b>Objectives:</b> The use of mechanical and oral antibiotic bowel preparation in the preoperative setting for gynecologic oncology surgery is controversial. One concern is its effects on body fluid physiology and the subsequent impact on postoperative renal function, especially in the setting of complex cytoreductive surgery (CRS) in ovarian cancer patients. The objective of this study was to examine the impact of bowel preparation on postoperative estimated creatinine clearance in patients undergoing cytoreductive surgery for ovarian cancer. <b>Methods:</b> We performed a retrospective review of patient data recorded in a prospectively collected university cancer center database. Patients with stage III or IV ovarian cancer who underwent primary or interval CRS were included. Patients without longitudinal follow-up were excluded. Patients were then divided into two groups: those who had a preoperative mechanical and oral antibiotic bowel preparation and those who did not. We collected information on demographics, medical comorbid conditions, and operative and oncologic characteristics. We also recorded preoperative, postoperative, and day of discharge estimated creatinine clearance, urine output, and total intravenous fluid (IVF) administered. The Chi-square test compared categorical variables and the t-test compared continuous variables. <b>Results:</b> A total of 831 patients met the criteria for analysis, of whom 221 (24%) had a preoperative bowel prep, and 610 (76%) did not. Demographics, medical comorbid conditions, cancer characteristics, and operative data were similar between both groups, except for significantly higher intraoperative IVF in those who underwent bowel prep than those who did not (2703 vs 1650 mL, p<0.001). There was no difference in preoperative estimated creatinine clearance (67 vs 68 mL/min, p=0.45), but estimated creatinine clearance on postoperative days one and two were significantly lower for patients who underwent bowel preparation (day one: 49 vs 69 mL/min, p-value <0.001; day two: 58 vs 72mL/min p<0.001). The estimated creatinine clearance for patients who underwent bowel preparation was fully recovered by the time of discharge (67 vs 65 mL/min, p=0.084). Patients who had bowel preparation received significantly more IVF than those who did not get bowel preparation on postop days one and two (day one: 1823 vs 1250 mL, p<0.001; day two: 1215 vs 783mL, p<0.001). There were no differences in urine output or units of blood transfused preoperatively or postoperatively. <b>Conclusions:</b> Use of preoperative bowel preparation for ovarian cancer CRS was associated with a transient statistically significant decrease in estimated creatinine clearance on postop days one and two that resolved by the time of discharge.Fig. 1