Department of Surgery, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Republic of Korea.
Int J Colorectal Dis. 2021 Sep;36(9):1929-1935. doi: 10.1007/s00384-021-03967-x. Epub 2021 Jun 5.
The guidelines for reducing surgical site infection in colorectal surgery recommend mechanical bowel preparation with oral antibiotics; however, this recommendation remains controversial. This study aimed to reveal the effect of oral antibiotics combined with mechanical bowel preparation in colorectal surgery.
This study was a nationwide population-based retrospective study. Data between January 1, 2016, and December 31, 2018, from the Korean National Health Insurance Service database were analyzed. Patients who underwent elective colorectal cancer surgery were included.
A total of 20,740 patients were finally included, comprising 14,554 (70.2%) who underwent mechanical bowel preparation alone and 6186 (29.8%) who underwent mechanical bowel preparation with oral antibiotics. The mechanical bowel preparation alone group was older than the mechanical bowel preparation with oral antibiotics group (65.7 ± 11.9 vs. 64.7 ± 11.8 years, p < 0.001). Rectal cancer patients and patients who underwent open surgery were more likely to receive mechanical bowel preparation with oral antibiotics. Patients who underwent mechanical bowel preparation with oral antibiotics demonstrated lower surgical-site infection rate (2.9% vs. 9.4%, p < 0.001), shorter hospital stay (11.7 ± 5.5 vs. 13.5 ± 7.3 days, p < 0.001), and lower medical cost (US$7414 ± 2762 vs. US$7791 ± 3235, p < 0.001) than those who underwent mechanical bowel preparation alone. The 30-day readmission rates and mortality were not significantly different.
The use of mechanical bowel preparation with oral antibiotics reduces surgical site infection, hospital stay, and medical cost in colorectal cancer surgery.
减少结直肠手术部位感染的指南推荐机械肠道准备联合口服抗生素；然而，这一推荐仍存在争议。本研究旨在揭示结直肠手术中口服抗生素联合机械肠道准备的效果。
本研究为全国性基于人群的回顾性研究。分析了 2016 年 1 月 1 日至 2018 年 12 月 31 日期间来自韩国国家健康保险服务数据库的数据。纳入接受择期结直肠癌手术的患者。
最终共纳入 20740 例患者，其中 14554 例（70.2%）仅接受机械肠道准备，6186 例（29.8%）接受机械肠道准备联合口服抗生素。单独接受机械肠道准备组的年龄大于接受机械肠道准备联合口服抗生素组（65.7±11.9 岁 vs. 64.7±11.8 岁，p<0.001）。直肠癌患者和接受开放性手术的患者更可能接受口服抗生素联合机械肠道准备。接受机械肠道准备联合口服抗生素的患者手术部位感染率较低（2.9% vs. 9.4%，p<0.001），住院时间较短（11.7±5.5 天 vs. 13.5±7.3 天，p<0.001），医疗费用较低（7414 美元±2762 美元 vs. 7791 美元±3235 美元，p<0.001），但 30 天再入院率和死亡率无显著差异。
在结直肠癌手术中使用机械肠道准备联合口服抗生素可降低手术部位感染、住院时间和医疗费用。
