A Statewide Assessment of Surgical Site Infection Following Colectomy

In Brief Objective: To determine the utility of adding oral nonabsorbable antibiotics to the bowel prep prior to elective colon surgery. Summary Background Data: Bowel preparation prior to colectomy remains controversial. We hypothesized that mechanical bowel preparation with oral antibiotics (compared with without) was associated with lower rates of surgical site infection (SSI). Methods: Twenty-four Michigan hospitals participated in the Michigan Surgical Quality Collaborative–Colectomy Best Practices Project. Standard perioperative data, bowel preparation process measures, and Clostridium difficile colitis outcomes were prospectively collected. Among patients receiving mechanical bowel preparation, a logistic regression model generated a propensity score that allowed us to match cases differing only in whether or not they had received oral antibiotics. Results: Overall, 2011 elective colectomies were performed over 16 months. Mechanical bowel prep without oral antibiotics was administered to 49.6% of patients, whereas 36.4% received a mechanical prep and oral antibiotics. Propensity analysis created 370 paired cases (differing only in receiving oral antibiotics). Patients receiving oral antibiotics were less likely to have any SSI (4.5% vs. 11.8%, P = 0.0001), to have an organ space infection (1.8% vs. 4.2%, P = 0.044) and to have a superficial SSI (2.6% vs. 7.6%, P = 0.001). Patients receiving bowel prep with oral antibiotics were also less likely to have a prolonged ileus (3.9% vs. 8.6%, P = 0.011) and had similar rates of C. difficile colitis (1.3% vs. 1.8%, P = 0.58). Conclusions: Most patients in Michigan receive mechanical bowel preparation prior to elective colectomy. Oral antibiotics may reduce the incidence of SSI. Using a statewide surgical quality collaborative, we evaluated the importance of oral antibiotics as part of bowel preparation prior to elective colon surgery. Using propensity matching, we noted significantly lower surgical site infection rates and low Clostridium difficile colitis rates in the group that received oral nonabsorbable antibiotics prior to surgery.