Ares Guillermo J, Helenowski Irene, Hunter Catherine J, Madonna Marybeth, Reynolds Marleta, Lautz Timothy
Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, 225 E Chicago Avenue, Box 63, Chicago, IL 60611; University of Illinois at Chicago, Department of Surgery, 840 South Wood Street, Suite 376-CSN, Chicago, IL 60612.
Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL 60611.
J Pediatr Surg. 2018 Apr;53(4):704-707. doi: 10.1016/j.jpedsurg.2017.03.060. Epub 2017 Mar 30.
The utility of mechanical bowel preparation (MBP) to minimize infectious complications in elective colorectal surgery is contentious. Though data is scarce in children, adult studies suggest a benefit to MBP when administered with oral antibiotics (OAB).
After IRB approval, the Pediatric Health Information System (PHIS) was queried for young children undergoing elective colon surgery from 2011 to 2014. Patients were divided into: no bowel preparation (Group 1), MBP (Group 2), and MBP plus OAB (Group 3). Statistical significance was determined using univariate and multivariate analysis with GEE models accounting for clustering by hospital.
One thousand five hundred eighty-one patients met study criteria: 63.7% in Group 1, 27.1% in Group 2, and 9.2% in Group 3. Surgical complication rate was higher in Group 1 (23.3%) compared to Groups 2 and 3 (14.2% and 15.5%; P<0.001). However, median length of stay was shorter in Group 1 (4, IQR 4days) compared to Group 2 (5, IQR 3) and Group 3 (6, IQR 3) (P<0.001). 30-day readmission rates were similar. In multivariate analysis compared to patients in Group 1, the odds of surgical complications were 0.72 (95% CI 0.40-1.29, P=0.28) with MBP alone (Group 2), 1.79 (95% CI 1.28-2.52, P=0.0008) with MBP+OAB (Group 3), and 1.13 (95% CI 0.81-1.58, P=0.46) for the aggregate Group 2 plus 3.
Utilization of bowel preparation in children is variable across children's hospitals nationally, and the benefit is unclear. Given the discrepancy with adult literature, a three-armed pediatric-specific randomized controlled trial is warranted.
Level III treatment study - retrospective comparative study.
机械性肠道准备（MBP）在择期结直肠手术中减少感染并发症的效用存在争议。尽管儿童相关数据稀少，但成人研究表明，联合口服抗生素（OAB）使用MBP有益。
经机构审查委员会（IRB）批准，查询2011年至2014年接受择期结肠手术的幼儿的儿科健康信息系统（PHIS）。患者分为：未进行肠道准备组（第1组）、MBP组（第2组）和MBP加OAB组（第3组）。采用单因素和多因素分析以及广义估计方程（GEE）模型确定统计学意义，该模型考虑了医院聚类情况。
1581例患者符合研究标准：第1组占63.7%，第2组占27.1%，第3组占9.2%。第1组手术并发症发生率（23.3%）高于第2组和第3组（分别为14.2%和15.5%；P<0.001）。然而，第1组的中位住院时间（4天，四分位间距4天）短于第2组（5天，四分位间距3天）和第3组（6天，四分位间距3天）（P<0.001）。30天再入院率相似。在多因素分析中，与第1组患者相比，单独使用MBP（第2组）发生手术并发症的几率为0.72（95%置信区间0.40 - 1.29，P = 0.28），使用MBP + OAB（第3组）为1.79（95%置信区间1.28 - 2.52，P = 0.0008），第2组和第3组合并组为1.13（95%置信区间0.81 - 1.58，P = 0.46）。
全国儿童医院中儿童肠道准备的使用情况各不相同，其益处尚不清楚。鉴于与成人文献存在差异，有必要开展一项针对儿科的三臂随机对照试验。
III级治疗研究——回顾性比较研究。
