From the Department of Surgery, University of Michigan, Ann Arbor, MI.
Ann Surg. 2014 Feb;259(2):310-4. doi: 10.1097/SLA.0b013e3182a62643.
To assess the utility of full bowel preparation with oral nonabsorbable antibiotics in preventing infectious complications after elective colectomy.
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.
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.
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).
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.
评估口服非吸收性抗生素进行全肠道准备在预防择期结肠切除术后感染性并发症中的作用。
择期结肠切除术前肠道准备仍存在争议。我们假设与无肠道准备相比，机械性肠道准备加用非吸收性口服抗生素可降低术后感染性并发症的发生率。
从密歇根外科质量协作-结肠切除术最佳实践项目中获取患者和临床数据。采用倾向评分分析根据主要暴露变量（全肠道准备[机械性肠道准备加用非吸收性口服抗生素]或无肠道准备[未给予机械性肠道准备和非吸收性口服抗生素]）对择期结肠切除术病例进行匹配。本研究的主要结局是手术部位感染和艰难梭菌结肠炎的发生。
共有 2475 例符合研究标准。倾向分析创建了 957 对病例（n = 1914），仅在肠道准备类型上存在差异。接受全准备的患者发生任何手术部位感染（5.0% vs 9.7%；P = 0.0001）、器官间隙感染（1.6% vs 3.1%；P = 0.024）和浅表手术部位感染（3.0% vs 6.0%；P = 0.001）的可能性较小。接受全准备的患者发生术后艰难梭菌结肠炎的可能性也较小（0.5% vs 1.8%，P = 0.01）。
在密歇根州，全肠道准备与择期结肠切除术后感染性并发症减少相关。在这种情况下，密歇根外科质量协作推荐在择期结肠切除术前进行全肠道准备。
