Bowel Preparation and Antibiotics Halve Surgical Complication Risk

A new study suggests that a combination of a mechanical bowel preparation (MBP) and oral antibiotics significantly reduces surgical site infection (SSI) and other complications after colorectal surgery.

Researchers at New York-Presbyterian Hospital/Columbia University Medical Center (NYP; New York, NY, USA) and Columbia University (New York, NY, USA) conducted a study involving 8,442 patients, of whom 27.2% had no preparation, 45.3% had MBP but without antibiotics, and 27.5% had both; baseline characteristics were similar in all patients. The researchers reviewed outcomes, particularly anastomotic leak, SSI, and ileus, to clarify whether bowel preparation or individual components impact specific outcomes after colorectal surgery.

The results showed that about 15% of patients who were not prepared developed a SSI and/or postoperative ileus. In comparison, only 6% of patients who underwent combined MBP and oral antibiotics developed these complications. On analysis, MBP with oral antibiotics was independently associated with a 43% reduction in anastomotic leak, 60% reduction in SSI, and a 39% reduction in postoperative ileus. The study was published in the September 2015 issue of Annals of Surgery.

“These data clarify the near 50-year debate whether bowel preparation improves outcomes after colorectal resection,” concluded lead author Professor of Surgery P. Ravi Kiran, MD, of NYP. “MBP with oral antibiotics reduces by nearly half, SSI, anastomotic leak, and ileus, the most common and troublesome complications after colorectal surgery.”

SSI’s may be the most frequent healthcare-associated infection after asymptomatic bacteriuria, representing a high burden on patients and hospitals in terms of morbidity, mortality, prolonged length of hospital stay, and additional costs, especially after gastrointestinal (GI) procedures. Researchers have been searching for decades for the optimal bowel preparation, but failed to address biological factors. Today, however, genome sequencing and microbiome studies have open up new areas for study that might give biological insight into what works best and for which patients.

Related Links:
New York-Presbyterian Hospital/Columbia University Medical Center 
Columbia University