The Role of Bowel Preparation in Open, Minimally Invasive, and Converted-to-Open Colectomy

Authors

Jiajun Luo, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.Follow
Zheng Liu, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Follow
Kevin Y. Pei, Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.Follow
Sajid A. Khan, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.Follow
Xiaoxu Wang, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.Follow
Ming Yang, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Follow
Xishan Wang, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: wxshan1208@126.com.Follow
Yawei Zhang, Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut. Electronic address: yawei.zhang@yale.edu.Follow

Document Type

Article

Publication Title

The Journal of surgical research

Abstract

BACKGROUND: Bowel preparation before colectomy is considered an effective strategy to decrease postoperative complications. However, data regarding the effect of bowel preparation in patients undergoing minimally invasive colectomy are limited. The aim of this study was to investigate the role of different bowel preparation strategies in patients undergoing open, minimally invasive, and converted-to-open elective colectomies. METHODS: We identified 39,355 patients who underwent elective colectomy from the American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database (2012-2016). Multivariate logistic regression models were used to assess the impact of different bowel preparation strategies on postoperative complications and mortality in three subapproach groups: open (n = 12,141), minimally invasive (n = 23,057), and converted to open (n = 4157). RESULTS: Overall, a total of 10,066 (25.6%) patients received no preparation (NP), 11,646 (29.5%) mechanical bowel preparation (MBP) alone, 1664 (4.2%) antibiotic bowel preparation (ABP) alone, and 15,979 (40.6%) MBP + ABP. Compared with NP, MBP + ABP showed the strongest protective effects. MBP + ABP was associated with reduced risk of major complications (odds ratio [OR] = 0.60, 95% confidence interval [CI]: 0.55-0.66), infectious complications (OR = 0.50, 95% CI: 0.46-0.54), any complications (OR = 0.55, 95% CI: 0.51-0.60), 30-d mortality (OR = 0.68, 95% CI: 0.48-0.96), anastomotic leak (OR = 0.50, 95% CI: 0.43-0.58), and length of stay ≥ 4 d (OR = 0.64, 95% CI: 0.61-0.67) in overall population. These protective effects, except for 30-d mortality, were observed in open, minimally invasive, and converted-to-open groups. When the analysis was limited to robotic surgery only, MBP + ABP was only associated with reduced risk of major complications (OR = 0.61, 95% CI: 0.38-0.97) compared with NP. The protective effects remained similar over the study time period. CONCLUSIONS: MBP + ABP is a preferred preoperative strategy in open, minimally invasive, and converted-to-open colectomy.

First Page

183

Last Page

192

DOI

10.1016/j.jss.2019.02.039

Publication Date

10-1-2019

Recommended Citation

Luo, Jiajun; Liu, Zheng; Pei, Kevin Y.; Khan, Sajid A.; Wang, Xiaoxu; Yang, Ming; Wang, Xishan; and Zhang, Yawei, "The Role of Bowel Preparation in Open, Minimally Invasive, and Converted-to-Open Colectomy" (2019). Surgery. 240.
https://scholar.bridgeporthospital.org/surgery/240

Identifier

31085366 (pubmed); 10.1016/j.jss.2019.02.039 (doi); S0022-4804(19)30105-2 (pii)