A European survey of bowel preparation in colorectal surgery

Devane, Liam; O'Connell, P. R.; Panis, Yves

doi:10.1111/codi.13905

Cited by 44 publications

(36 citation statements)

References 25 publications

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“…The administration of prophylactic intravenous antibiotics on induction of anaesthesia is now routine, whereas the use of preoperative oral antibiotics remains limited, as reported in a recent European survey and international audit. Evidence, largely from the USA and Japan, has been summarized by several meta‐analyses reporting a reduction in postoperative infective complications following the use of oral in addition to intravenous antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Effect of preoperative oral antibiotics in combination with mechanical bowel preparation on inflammatory response and short‐term outcomes following left‐sided colonic and rectal resections

et al. 2019

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Background Preoperative oral antibiotics in addition to intravenous antibiotics and mechanical bowel preparation (MBP) may influence the gut microbiome and reduce both the postoperative systemic inflammatory response to surgery and postoperative infective complications following colorectal resection. This propensity score‐matched study compared outcomes of patients undergoing left‐sided colonic or rectal resection with or without a combination of oral antibiotics and MBP. Methods The addition of oral antibiotics and MBP to prophylactic intravenous antibiotics in left‐sided colonic and rectal resections was introduced in 2015–2016 at a single institution. Propensity score matching was undertaken to compare the effects of oral antibiotics plus MBP versus neither oral antibiotics nor MBP on the postoperative systemic inflammatory response and short‐term outcomes in patients undergoing left‐sided colonic or rectal resection between 2013 and 2018. Results Of 396 patients who had propensity score matching for host, anaesthetic and operative factors, 204 matched patients were identified. The addition of oral antibiotics and MBP was associated with a significantly reduced postoperative inflammatory response (reduced postoperative Glasgow Prognostic Score) on day 3 (odds ratio (OR) 0·66, 95 per cent c.i. 0·44 to 0·99; P = 0·013) and day 4 (OR 0·46, 0·30 to 0·71; P = 0·001). Significantly reduced overall complications (OR 0·31, 0·17 to 0·56; P < 0·001), infective complications (OR 0·41, 0·22 to 0·77; P = 0·011), surgical‐site infection (OR 0·37, 0·17 to 0·83; P = 0·024) and postoperative length of hospital stay (median 7 days versus 8 days in patients who had intravenous antibiotics alone; P = 0·050) were also observed. Conclusion Preoperative oral antibiotics and MBP in addition to prophylactic intravenous antibiotics were associated with a reduction in the postoperative systemic inflammatory response and postoperative complications in patients undergoing resectional left‐sided colonic or rectal surgery.

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Section: Introductionmentioning

confidence: 99%

Effect of preoperative oral antibiotics in combination with mechanical bowel preparation on inflammatory response and short‐term outcomes following left‐sided colonic and rectal resections

et al. 2019

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“…The lack of evidence to demonstrate the efficacy of MBP to reduce rates of SSI, its potential adverse effects, and the emergence of multi-modal rehabilitation programs have prompted a decrease in its utilization. In 2017, a European survey showed an oral prophylaxis use of only 11% and a routine use of MBP of 29.6% [7]. The expert panel for the present study concluded, however, that clinical trials show a decrease in SSI when prophylaxis with oral antibiotic agents is combined with MBP [16].…”

Section: Discussionmentioning

confidence: 57%

“…The multitude of preventive measures has demonstrated varying levels of efficacy and adoption [6]. Some measures, such as mechanical bowel preparation (MBP) and oral antibiotic prophylaxis, are specific for colorectal operations and are used irregularly [7]. A gap may exist between the best scientific evidence and clinical practice as far as SSI avoidance in colorectal surgical procedures are concerned.…”

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confidence: 99%

Awareness of Practice and Comparison with Best Evidence in Surgical Site Infection Prevention in Colorectal Surgery

Badia

Casey

Rubio-Pérez

et al. 2020

Surgical Infections

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Background: The use of mechanical bowel preparation and prophylaxis with oral antimicrobial agents can prevent surgical site infection (SSI) in colorectal surgical procedures, but routine adoption of these and other practices by surgeons has been limited. The aim of this study was to determine the actual practice and surgeon beliefs about preventative measures in elective colorectal operations and to compare them with established recommendations. Methods: Web-based survey was sent to colorectal surgeons assessing knowledge, beliefs, and practices regarding the use of preventative measures for SSI. Results: Of 355 surgeons, 33% had no feedback of SSI rate; 60% believed in evidence for normothermia, wound edge protection, and use of alcohol solution, and reported use of these strategies. There was a discrepancy in the assumed evidence and use of hyperoxia, glove replacement after anastomosis, surgical tools replacement, and saline surgical site lavage. Most of respondents believe that oral antibiotic prophylaxis diminishes infection, but is indicated only by one third of them. Few surgeons believe in MBP, but many actually use it. Most surgeons believe that there is a discrepancy between published guidelines and actual clinical practice. As proper means to implement guidelines, checklists, standardized orders, surveillance, feedback of SSI rates, and educational programs are rated most highly by surgeons, but few of these are in place at their institutions. Conclusions: Gaps in the translation of evidence into practice remain in the prevention of SSI in colorectal surgical procedures. Several areas for improvement have been identified. Specific implementation strategies should be addressed in colorectal units.

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“…Surveys have shown a change in the use of laparoscopic procedures compared with open procedures depending on the type of preparation used. A survey from the European Society of Coloproctology (ESCP) found that the routine use of MBP prescribed by laparoscopic surgeons was significantly lower (19.7 vs 51.5%, P < 0.01) [ 22 ]. By contrary, a survey from the UK showed that a higher proportion of laparoscopic right-sided procedures was performed with MBP compared with open procedures (16.8 vs 9.5%; P = 0.08); however, the need for MBP for a left-sided procedure remains controversial [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, it is becoming increasingly clear that MBP + OAP combined with intravenous antibiotics is the most effective method. Previous surveys from the USA, Europe, and Japan have shown a low rate of oral antibiotic usage [ 17 – 19 , 22 ]. This obviously contrasts with the patterns of practice in China, because nearly 40% of the respondents prescribed OAP in regimens, meanwhile 49.3% prescribed a longer duration (> 3 days) of postoperative intravenous antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Current practice patterns of preoperative bowel preparation in colorectal surgery: a nation-wide survey by the Chinese Society of Colorectal Cancer

et al. 2018

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BackgroundThe optimal preoperative bowel preparation for colorectal surgery remains controversial. However, recent studies have established that bowel preparation varies significantly among countries and even surgeons at the same institution. This survey aimed to obtain information on the current practice patterns of bowel preparation for colorectal surgery in China.MethodsA paper-based survey was circulated to the members of the Chinese Society of Colorectal Cancer (CSCC). The survey responses were collected and analyzed. Statistical analysis was performed for all the categorical variables according to the responses to individual questions.ResultsThree hundred forty-one members completed the questionnaire. Regarding surgical practice, 203 (59.5%) performed > 50% of the colorectal operations laparoscopically or robotically; the use of mechanical bowel preparation (MBP) alone was significantly higher (63.5 vs 31.9%; P < 0.001). The respondents who performed > 200 colonic or rectal resections provided significantly more MBP alone (79.6 vs 39.1%, P < 0.001; 76.6 vs 43.2%, P < 0.001; respectively). Among hospitals with fewer than 500 beds, 52.4% of the respondents used MBP + oral antibiotics preparation (OAP) + enema, a significantly higher percentage than the respondents of hospitals with more than 500 beds (P < 0.001). Nearly 40% of the respondents prescribed OAP in regimens; meanwhile, 74.8% prescribed preoperative intravenous antibiotics.ConclusionsThe study demonstrates considerable variation among members from the CSCC. These findings should be considered when developing multicenter trials and to provide more definitive answers.Electronic supplementary materialThe online version of this article (10.1186/s12957-018-1440-4) contains supplementary material, which is available to authorized users.

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A European survey of bowel preparation in colorectal surgery

Abstract: Among the majority of respondents to this survey, MBP is used routinely for rectal operations. For colonic surgery, laparoscopic surgeons have a significantly lower use of MBP. Use of oral antibiotic bowel preparation remains uncommon.

Cited by 44 publications

References 25 publications

Effect of preoperative oral antibiotics in combination with mechanical bowel preparation on inflammatory response and short‐term outcomes following left‐sided colonic and rectal resections

Effect of preoperative oral antibiotics in combination with mechanical bowel preparation on inflammatory response and short‐term outcomes following left‐sided colonic and rectal resections

Awareness of Practice and Comparison with Best Evidence in Surgical Site Infection Prevention in Colorectal Surgery

Current practice patterns of preoperative bowel preparation in colorectal surgery: a nation-wide survey by the Chinese Society of Colorectal Cancer

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