Garfinkle Richard, Abou-Khalil Jad, Morin Nancy, Ghitulescu Gabriela, Vasilevsky Carol-Ann, Gordon Philip, Demian Marie, Boutros Marylise
Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
Dis Colon Rectum. 2017 Jul;60(7):729-737. doi: 10.1097/DCR.0000000000000851.
Recent studies demonstrated reduced postoperative complications using combined mechanical bowel and oral antibiotic preparation before elective colorectal surgery.
The aim of this study was to assess the impact of these 2 interventions on surgical site infections, anastomotic leak, ileus, major morbidity, and 30-day mortality in a large cohort of elective colectomies.
This is a retrospective comparison of 30-day outcomes using the American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database with coarsened exact matching.
Interventions were performed in hospitals participating in the national surgical database.
Adult patients who underwent elective colectomy from 2012 to 2014 were included.
Preoperative bowel preparations were evaluated.
The primary outcomes measured were surgical site infections, anastomotic leak, postoperative ileus, major morbidity, and 30-day mortality.
A total of 40,446 patients were analyzed: 13,219 (32.7%), 13,935 (34.5%), and 1572 (3.9%) in the no-preparation, mechanical bowel preparation alone, and oral antibiotic preparation alone groups, and 11,720 (29.0%) in the combined preparation group. After matching, 9800, 1461, and 8819 patients remained in the mechanical preparation, oral antibiotic preparation, and combined preparation groups for comparison with patients without preparation. On conditional logistic regression of matched patients, oral antibiotic preparation alone was protective of surgical site infection (OR, 0.63; 95% CI, 0.45-0.87), anastomotic leak (OR, 0.60; 95% CI, 0.34-0.97), ileus (OR, 0.79; 95% CI, 0.59-0.98), and major morbidity (OR, 0.73; 95% CI, 0.55-0.96), but not mortality (OR, 0.32; 95% CI, 0.08-1.18), whereas a regimen of combined oral antibiotics and mechanical bowel preparation was protective for all 5 major outcomes. When directly compared with oral antibiotic preparation alone, the combined regimen was not associated with any difference in any of the 5 postoperative outcomes.
This study was limited by its retrospective design with heterogeneous data.
Oral antibiotic preparation alone significantly reduced surgical site infection, anastomotic leak, postoperative ileus, and major morbidity after elective colorectal surgery. A combined regimen of oral antibiotics and mechanical bowel preparation offered no superiority when compared with oral antibiotics alone for these outcomes. See Video Abstract at http://links.lww.com/DCR/A358.
近期研究表明，在择期结直肠手术前联合使用机械肠道准备和口服抗生素制剂可减少术后并发症。
本研究旨在评估这两种干预措施对一大群择期结肠切除术患者手术部位感染、吻合口漏、肠梗阻、严重并发症和30天死亡率的影响。
这是一项回顾性比较研究，使用美国外科医师学会国家外科质量改进计划中针对结肠切除术的数据库，并进行精确匹配。
干预措施在参与国家外科数据库的医院中进行。
纳入2012年至2014年接受择期结肠切除术的成年患者。
评估术前肠道准备情况。
测量的主要结局包括手术部位感染、吻合口漏、术后肠梗阻、严重并发症和30天死亡率。
共分析了40446例患者：未进行准备组13219例（32.7%），仅进行机械肠道准备组13935例（34.5%），仅进行口服抗生素准备组1572例（3.9%），联合准备组11720例（29.0%）。匹配后，机械准备组、口服抗生素准备组和联合准备组分别有9800例、1461例和8819例患者与未进行准备的患者进行比较。在对匹配患者进行条件逻辑回归分析时，仅口服抗生素准备可预防手术部位感染（比值比[OR]，0.63；95%置信区间[CI]，0.45 - 0.87）、吻合口漏（OR，0.60；95% CI，0.34 - 0.97）、肠梗阻（OR，0.79；95% CI，0.59 - 0.98）和严重并发症（OR，0.73；95% CI，0.55 - 0.96），但不能预防死亡率（OR，0.32；95% CI，0.08 - 1.18），而口服抗生素与机械肠道准备联合方案对所有5项主要结局均有预防作用。与仅口服抗生素准备直接比较时，联合方案在5项术后结局中均无差异。
本研究受回顾性设计和数据异质性的限制。
仅口服抗生素准备可显著降低择期结直肠手术后的手术部位感染、吻合口漏、术后肠梗阻和严重并发症。对于这些结局，口服抗生素与机械肠道准备联合方案与仅口服抗生素相比并无优势。见视频摘要：http://links.lww.com/DCR/A358 。
