A Statewide Colectomy Experience

In Brief Objective: To assess the utility of full bowel preparation with oral nonabsorbable antibiotics in preventing infectious complications after elective colectomy. Background: Bowel preparation before elective colectomy remains controversial. We hypothesize that mechanical bowel preparation with nonabsorbable oral antibiotics is associated with a decreased rate of postoperative infectious complications when compared with no bowel preparation. Methods: Patient and clinical data were obtained from the Michigan Surgical Quality Collaborative–Colectomy Best Practices Project. Propensity score analysis was used to match elective colectomy cases based on primary exposure variable—full bowel preparation (mechanical bowel preparation with nonabsorbable oral antibiotics) or no bowel preparation (neither mechanical bowel preparation given nor nonabsorbable oral antibiotic given). The primary outcomes for this study were occurrence of surgical site infection and Clostridium difficile colitis. Results: In total, 2475 cases met the study criteria. Propensity analysis created 957 paired cases (n = 1914) differing only by the type of bowel preparation. Patients receiving full preparation were less likely to have any surgical site infection (5.0% vs 9.7%; P = 0.0001), organ space infection (1.6% vs 3.1%; P = 0.024), and superficial surgical site infection (3.0% vs 6.0%; P = 0.001). Patients receiving full preparation were also less likely to develop postoperative C difficile colitis (0.5% vs 1.8%, P = 0.01). Conclusions: In the state of Michigan, full bowel preparation is associated with decreased infectious complications after elective colectomy. Within this context, the Michigan Surgical Quality Collaborative recommends full bowel preparation before elective colectomy. Bowel preparation before elective colectomy remains controversial. This study represents the largest to date study comparing no bowel preparation with full bowel preparation with oral nonabsorbable antibiotics. Patients receiving full bowel preparation experienced significantly fewer postoperative infectious complications than a propensity-matched cohort receiving no preoperative bowel preparation.