Why the study?
It remained unclear whether bowel preparation in elective colectomies leads to improved outcomes in patients with diverticulitis.
Does bowel preparation reduce surgical site infections and anastomotic leakage in diverticulitis patients undergoing elective colectomies?
Does bowel preparation reduce surgical site infections and anastomotic leakage in diverticulitis patients undergoing elective colectomies?
The combination of mechanical and antibiotic bowel preparation prior to elective colectomy for diverticulitis is associated with significantly reduced rates of surgical site infections, anastomotic leakage, and 30-day mortality.
May support MBP+ABP to lower SSI/AL in elective diverticulitis colectomy; hypothesis-generating, requires prospective confirmation before practice change.
Background:Recent data based on large databases show that bowel preparation (BP) is associated with improved outcomes in patients undergoing elective colorectal surgery. However, it remains unclear whether BP in elective colectomies would lead to similar results in patients with diverticulitis. The purpose of this study was to investigate whether bowel preparation influences surgical site infections (SSI) and anastomotic leakage (AL) in patients with diverticulitis undergoing elective colectomies. Study design:We identified 16,380 diverticulitis patients who underwent elective colectomies from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) colectomy targeted database (2012-2017). Multivariate logistic regression models were employed to assess the impact of different bowel preparation strategies on postoperative complications, including SSI and AL.Results:In the identified population, a total of 2,524 patients (15.4%) received no preparation (NP), 4,715 (28.8%) mechanical bowel preparation (MBP) alone, 739 (4.5%) antibiotic bowel preparation (ABP) alone, and 8,402 (51.3%) MBP + ABP. Compared to NP, patients who received any type of bowel preparations showed a significant decrease in rates of SSI and AL after adjustment for potential confounders (SSI: MBP [OR=0.82, 95%CI: 0.70-0.96], ABP [0.69, 95%CI: 0.52-0.92]; AL: MBP [OR=0.66, 95%CI: 0.51-0.86], ABP [0.56, 95%CI: 0.34-0.93]), where the combination type of MBP+ABP had the strongest association with a decreased risk (SSI:OR=0.58, 95%CI:0.50-0.67; AL:OR=0.46, 95%CI:0.36-0.59). The significantly decreased risk of 30-day mortality was observed in the bowel preparation of MBP + ABP only (OR=0.32, 95%CI: 0.13-0.79). After further stratification by surgery procedure, patients who received MBP + ABP showed consistently lower risk for both SSI and AL when undergoing open and laparoscopic surgeries (Open: SSI [OR=0.51, 95%CI: 0.37-0.69], AL[OR=0.47, 95%CI: 0.25-0.91]; Laparoscopic: SSI[OR=0.58, 95%CI: 0.47-0.72, AL[OR=0.49, 95%CI: 0.35-0.68]).Conclusions:MBP + ABP for diverticulitis patients undergoing elective open or laparoscopic colectomies is associated with decreased rates of SSI and AL and 30-day mortality. Benefits of MBP + ABP for diverticulitis patients undergoing robotic surgeries warrant further investigation.
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Zhuo et al. (2022) studied this question.
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