Division of Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
Surg Infect (Larchmt). 2022 Jun;23(5):436-443. doi: 10.1089/sur.2022.032. Epub 2022 Apr 22.
Use of pre-operative bowel preparation in colorectal resection has not been examined solely in patients who have had colorectal resection with primary colostomy (Hartmann procedure). We aimed to evaluate the association of bowel preparations with short-term outcomes after non-emergent Hartmann procedure. The National Surgical Quality Improvement Program Participant Use File colectomy database was queried for patients who had elective open or laparoscopic Hartmann operation. Patients were grouped by pre-operative bowel preparation: no bowel preparation, oral antibiotic agents, mechanical preparation, or both mechanical and oral antibiotic agent preparation (combined). Propensity analysis was performed, and outcomes were compared by type of pre-operative bowel preparation. The primary outcome was rate of any surgical site infection (SSI). Secondary outcomes included overall complication, re-operation, re-admission, colitis, and length of stay. Of the 4,331 records analyzed, 2,040 (47.1%) patients received no preparation, 251 (4.4%) received oral antibiotic preparation, 1,035 (23.9%) received mechanical bowel preparation, and 1,005 (23.2%) received combined oral antibiotic and mechanical bowel preparation. After propensity adjustment, rates of any SSI, overall complication, and length of hospital stay varied significantly between pre-operative bowel regimens (p < 0.005). The use of combined bowel preparation was associated with decreased rate of SSI, overall complication, and length of stay. No difference in rate of re-operation or post-operative infection was observed based on bowel preparation. Compared with no pre-operative bowel preparation, any bowel preparation was associated with reduced rate of SSI, but not rate of re-operation or post-operative infection.
在接受结直肠切除和结肠造口术（Hartmann 手术）的患者中，仅评估了术前肠道准备对非紧急 Hartmann 手术后短期结局的影响。本研究旨在评估术前肠道准备与择期开腹或腹腔镜 Hartmann 手术患者短期结局的关系。通过全国外科质量改进计划参与者使用文件结肠切除术数据库，检索接受择期开腹或腹腔镜 Hartmann 手术的患者。根据术前肠道准备情况将患者分为无肠道准备、口服抗生素、机械性肠道准备或机械性和口服抗生素联合准备（联合组）。采用倾向性分析，并根据术前肠道准备类型比较结局。主要结局是任何手术部位感染（SSI）的发生率。次要结局包括总并发症、再次手术、再次入院、结肠炎和住院时间。在分析的 4331 份记录中，2040 例（47.1%）患者未接受肠道准备，251 例（4.4%）接受口服抗生素准备，1035 例（23.9%）接受机械性肠道准备，1005 例（23.2%）接受口服抗生素和机械性肠道准备联合方案。经过倾向性调整后，术前肠道准备方案之间 SSI 发生率、总并发症发生率和住院时间存在显著差异（p < 0.005）。联合肠道准备与 SSI、总并发症和住院时间发生率降低有关。根据肠道准备情况，再次手术或术后感染的发生率无差异。与无术前肠道准备相比，任何肠道准备都与 SSI 发生率降低相关，但与再次手术或术后感染的发生率无关。
