A Statewide Assessment of Surgical Site Infection Following Colectomy

Abstract

Objective-To determine the utility of adding oral non-absorbable antibiotics to the bowel prep prior to elective colon surgery Summary background data-Bowel preparation prior to colectomy remains controversial. We hypothesized that mechanical bowel preparation with oral antibiotics (compared to without) was associated with lower rates of SSI. Methods-24Michigan hospitals participated in the Michigan Surgical Quality CollaborativeColectomy Best Practices Project. Standard peri-operative data, bowel preparation process measures and C.difficile colitis outcomes were prospectively collected. Among patients receiving mechanical bowel preparation, a logistic regression model generated a propensity score that allowed us to match cases differing only in whether or not they had received oral antibiotics.Results-Overall, 2011 elective colectomies were performed over 16 months. Mechanical bowel prep without oral antibiotics was administered to 49.6% of patients, while 36.4% received a mechanical prep and oral antibiotics. Propensity analysis created 370 paired cases (differing only in receiving oral antibiotics). Patients receiving oral antibiotics were less likely to have any SSI (4.5% vs.11.8%, p = 0.0001), to have an organ space infection (1.8% vs. 4.2%, p = 0.044) and to have a superficial SSI (2.6% vs. 7.6%, p = 0.001). Patients receiving bowel prep with oral antibiotics were also less likely to have a prolonged ileus (3.9% vs. 8.6%, p = 0.011) and had similar rates of C. difficile colitis (1.3% vs. 1.8%, p = 0.58).Conclusions-Most patients in Michigan receive mechanical bowel preparation prior to elective colectomy. Oral antibiotics may reduce the incidence of SSI.

Surgical Site Infection Prevention

“…Oral antibiotics were associated with a decreased SSI rate and this finding was corroborated by a meta-analysis of 13 other trials demonstrating that oral antibiotic use was associated with decreased SSI. Most recently, evaluation of the Michigan Surgical Quality Collaborative (MSQC) data (NSQIP methodology) using a propensity matched analysis found that patients who received oral antibiotics and mechanical bowel preparation as compared to those receiving mechanical bowel preparation alone had a lower rate of superficial and organ space infections [ 31 ]. Similar results were found with analysis of the Veterans Affairs Hospital data.…”

Meta‐analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgical‐site infections in elective colorectal surgery

“…After assessment of full‐text articles of the remaining 43 studies, 18 studies were excluded owing to the lack of MBP, prolonged courses of preoperative oral antibiotics, or the inclusion of patients undergoing emergency or urgent surgery. A further three studies were excluded as they were duplicate publications using cohorts already included in the meta‐analysis11, 12, 13. The remaining 22 studies were included in the review, of which 14 were RCTs14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and eight were observational cohorts2 4, 28, 29, 30, 31, 32, 33 ( Table 1; Table   S1, supporting information).…”

Are gut bacteria associated with the development of anastomotic leaks?

“…On the other hand, many trials show the benefit of adding oral antibiotics to mechanical bowl preparation to prepare their patients for gastrointestinal surgery in order to prevent infections and anastomotic leak. Most surgeons in the recent past did not routinely follow this concept [6,7].…”