Has network meta‐analysis resolved the controversies related to bowel preparation in elective colorectal surgery?

Woodfield, John C.; Clifford, Kari; Schmidt, Barry; Thompson‐Fawcett, Mark

doi:10.1111/codi.16194

Cited by 8 publications

(5 citation statements)

References 56 publications

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“…Postoperative complication rates of the patients were analyzed according to the Clavien-Dindo complication grade and when all groups were evaluated, major complication (3b and above) was seen in 35 Mortality was observed in 13 (8.6%), one (0.9%), four (2.4%) patients in the right colectomy, left colectomy, and rectosigmoid resection groups, respectively. There was no statistically significant difference between the groups regarding anastomotic leakage, intraabdominal collection, reoperation, wound infection, extraintestinal infection, and p values were 0.093, 0.31, 0.251, 0.612, and 0.234, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…In a meta-analysis involving 5107 patients in 10 randomized controlled trials, patients have been grouped as IV antibiotics only, MBP with IV antibiotics, IV and oral antibiotics and MBP with oral antibiotics. Although there was no difference in terms of anastomotic leakage; SSI was seen to be reduced by more than 50% in patients who did not undergo MBP (35). In another meta-analysis, the analysis included a total of 22 studies involving 8852 patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

Benli,

Tikici,

Baysan

et al. 2023

Turk J Surg

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Objective: Despite being routinely used before elective colorectal surgery in most surgical clinics, mechanical bowel preparation (MBP) remains controversial. This study aimed to investigate postoperative complications and outcomes of right, left, or rectosigmoid resection without MBP. Material and Methods: Patients who underwent elective colorectal surgery without mechanical bowel preparation and oral antibiotics between January 2011 and December 2021 were included in the study. Patients were categorized according to the side of resection, and these subgroups were compared for anastomotic leakage, surgical site infections (SSI), and overall morbidity measured using the Clavien-Dindo complication grade. Results: Data of 422 patients were analyzed. Overall anastomotic leakage was found in 14 patients (3.3%), SSI in 46 (10.9%), collection in 14 (3.3%), mortality in 18 (4.3%), and reoperation in 17 (%4) patients. Anastomotic leakage was observed in six (3.9%) in right colectomy, two (1.9%) in left colectomy, and in six (3.7%) patients in the rectosigmoid resection group when the groups were evaluated separately. There was no statistical difference between the groups (p= 0.630). Furthermore, there was no statistical difference between the groups regarding collection and reoperation (p values were p= 0.31, and p= 0.251, respectively). Conclusion: Study results showed that anastomotic leakage, surgical site infection, intra-abdominal collection, reoperation, and mortality rates were similar to the current literature obtained from the studies with mechanical bowel preparation. In addition, these results were found to be similar according to the resection site.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

Benli,

Tikici,

Baysan

et al. 2023

Turk J Surg

View full text Add to dashboard Cite

show abstract

“…Due to the impact of postoperative complications on patients' quality of life and the dynamic nature of CRC surgery, a significant controversy surrounds the most effective preoperative interventions for elective CRC surgery [13]. Beyond the traditional approaches of using MBP alone or combined with macrolide oAB, alternative methods, such as using different antibiotic regimens or employing oAB alone without MBP, are emerging.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Mechanical Bowel Preparation and Oral Antibiotics in Colorectal Cancer Surgery (MECCA Study): A Prospective Randomized Clinical Trial

Frountzas,

Michalopoulou,

Georgiou

et al. 2024

JCM

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Background: Colorectal cancer surgery has been associated with surgical site infections (SSIs), leading to an increase in postoperative morbidity, length of stay and total cost. The aim of the present randomized study was to investigate the relationship between the preoperative administration of oral antibiotic therapy and SSI rate, as well as other postoperative outcomes in patients undergoing colorectal cancer surgery. Material and Methods: Patients who underwent colorectal cancer surgery in a university surgical department were included in the present study. Patients were randomized into two groups using the “block randomization” method. The intervention group received three doses of 400 mg rifaximin and one dose of 500 mg metronidazole per os, as well as mechanical bowel preparation the day before surgery. The control group underwent only mechanical bowel preparation the day before surgery. The study has been registered in ClinicalTrials.gov (NCT03563586). Results: Two hundred and five patients were finally included in the present study, 97 of whom received preoperative antibiotic therapy per os (intervention group). Patients of this group demonstrated a significantly lower SSI rate compared with patients who did not receive preoperative antibiotic therapy (7% vs. 16%, p = 0.049). However, preoperative antibiotic administration was not correlated with any other postoperative outcome (anastomotic leak, overall complications, readmissions, length of stay). Conclusions: Preoperative antibiotic therapy in combination with mechanical bowel preparation seemed to be correlated with a lower SSI rate after colorectal cancer surgery.

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“…Furthermore, bundles may be easy to introduce in a single hospital, but the feasibility of implementing comprehensive SSI prevention bundles within a larger and more diverse population of hospitals is unclear, and their clinical efficacy has not been well established 27 . Regarding the choice of the components of a colorectal bundle, recent meta-analyses support the efficacy of bundles, including oral antibiotic prophylaxis (OAP), to reduce SSI but also note that certain questions remain unanswered and that well-designed pragmatic studies are needed 28 .…”

Section: Introductionmentioning

confidence: 99%

Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective, and multicenter cohort study

Badía

Arroyo-García

Vázquez

et al. 2023

International Journal of Surgery

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Background: Bundled interventions usually reduce surgical site infection (SSI) when implemented at single hospitals, but the feasibility of their implementation at the nationwide level and their clinical results are not well established. Materials and Methods: Pragmatic interventional study to analyze the implementation and outcomes of a colorectal surgery care bundle within a nationwide quality improvement program. The bundle consisted of antibiotic prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation, laparoscopy, normothermia, and a wound retractor. Control group (CG) and Intervention group (IG) were compared. Overall SSI, superficial (S-SSI), deep (D-SSI), and organ/space (O/S-SSI) rates were analyzed. Secondary endpoints included microbiology, 30-day mortality, and length of hospital stay. Results: A total of 37 849 procedures were included, 19 655 in the CG and 18 194 in the IG. In all, 5462 SSIs (14.43%) were detected: 1767 S-SSI (4.67%), 847 D-SSI (2.24%), and 2838 O/S-SSI (7.5%). Overall SSI fell from 18.38% (CG) to 10.17% (IG), odds ratio (OR) of 0.503 [0.473–0.524]. O/S-SSI rates were 9.15% (CG) and 5.72% (IG), OR of 0.602 [0.556–0.652]. The overall SSI rate was 16.71% when no measure was applied and 6.23% when all six were used. Bundle implementation reduced the probability of overall SSI (OR: 0.331; CI95: 0.242–0.453), and also O/S-SSI rate (OR: 0.643; CI95: 0.416–0.919). In the univariate analysis, all measures except normothermia were associated with a reduction in overall SSI, while only laparoscopy, OAP, and mechanical bowel preparation were related to a decrease in O/S-SSI. Laparoscopy, wound retractor, and OAP decreased overall SSI and O/S-SSI in the multivariate analysis. Conclusions: In this cohort study, the application of a specific care bundle within a nationwide nosocomial infection surveillance system proved feasible and resulted in a significant reduction in overall and O/S-SSI rates in the elective colon and rectal surgery. The OR for SSI fell between 1.5 and 3 times after the implementation of the bundle.

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Has network meta‐analysis resolved the controversies related to bowel preparation in elective colorectal surgery?

Cited by 8 publications

References 56 publications

Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

The Impact of Mechanical Bowel Preparation and Oral Antibiotics in Colorectal Cancer Surgery (MECCA Study): A Prospective Randomized Clinical Trial

Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective, and multicenter cohort study

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