Preoperative mechanical bowel preparation with oral antibiotics reduces surgical site infection after elective colorectal surgery for malignancies: results of a propensity matching analysis

Purun Lei,Yujie Hou,Ying Ruan,Tufeng Chen,Xiaofeng Yang,Hongbo Wei,Juekun Wu

doi:10.1186/s12957-020-1804-4

Abstract

BackgroundSurgical site infections (SSIs) are a major postoperative complication after colorectal surgery. Current study aims to evaluate prophylactic function of oral antibiotic (OA) intake in combination with mechanical bowel preparation (MBP) relative to MBP alone with respect to postoperative SSI incidence.MethodsA retrospective analysis of eligible patients was conducted using the databases of the Gastrointestinal Surgery Centre, Third Affiliated Hospital of Sun Yat-sen University from 2011 to 2017. Data pertaining to postoperative hospital stay length, expenses, SSI incidence, anastomotic fistula incidence, and rates of other complications were extracted and compared. A propensity analysis was conducted to minimize bias associated with demographic characteristics. Subgroup analyses were performed to further explore protective effects of OA in different surgical sites.ResultsThe combination of OAs and MBP was related to a significant decrease in the incidence of overall SSIs, superficial SSI, and hospitalization expenses. The MBP + OA modality was particularly beneficial for patients undergoing left-side colon or rectum resections, with clear prophylactic efficacy. The combination of MPB + OA did not exhibit significant prophylactic efficacy in patients undergoing right hemi-colon resection. Age, surgical duration, and application of OA were all independent factors associated with the occurrence of SSIs.ConclusionThese results suggest that the combination of OA + MBP should be recommended for patients undergoing elective colorectal surgery, particularly for operations on the left side of the colon or rectum.Trial registrationNCT04258098. Retrospectively registered

Highlights

Surgical site infections (SSIs) are a major postoperative complication after colorectal surgery
The merit of oral antibiotic (OA) and mechanical bowel preparation (MBP) has been rediscovered in several related retrospective studies, which demonstrated a significant decrease in the rate of SSIs [15,16,17]
The current study revealed that the application of MBP + OA can significantly decrease the overall incidence of SSIs (10.59% vs 16.56%, p = 0.03) and expenses (56.74 ± 16.60 vs 66.73 ± 25.66 kRMB, p < 0.05) relative to MBP alone in patients undergoing elective colorectal resection

Summary

Introduction

Surgical site infections (SSIs) are a major postoperative complication after colorectal surgery. Surgical site infections (SSIs) are a major postoperative complication after abdominal surgery, especially in the colorectal field [1]. As information in these trials were exacted from national databases without any detailed matching between patient groups, the existence of bias in these trials may affect the validity of their results. None of these studies assessed the relative prophylactic effects of the novel MBP mode in right or left-side colorectal surgery. We report on our experiences in a single-center comparison of MBP + OA with MBP alone, assessing the rates of prophylactic combinations between groups via propensity score matching and stratification

Methods

Results

Discussion

Conclusion