Jalalzadeh Hasti, Wolfhagen Niels, Harmsen Wouter J, Griekspoor Mitchel, Boermeester Marja A
From the Amsterdam UMC location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, The Netherlands.
Amsterdam Gastroenterology Endocrinology & Metabolism (AGEM), Amsterdam, The Netherlands.
Ann Surg Open. 2022 Jun 23;3(3):e175. doi: 10.1097/AS9.0000000000000175. eCollection 2022 Sep.
To compare the effect of different methods of bowel preparation on the incidence of surgical site infections (SSI), anastomotic leakage (AL), and mortality in patients undergoing elective colorectal surgery.
Recent guidelines advise mechanical bowel preparation with oral antibiotics (MBP-OA) for the prevention of SSI in colorectal surgery. Recent trials suggest oral antibiotics (OA) alone may be sufficient.
PubMed, MEDLINE, and Embase were searched from inception until 10-08-2021. We included randomized controlled trials (RCTs) comparing multiple methods of bowel preparation (mechanical bowel preparation [MBP], OA, MBP-OA, or no preparation) with regards to clinical outcomes such as incidence of SSI, AL, and mortality rates. A frequentist random-effects network meta-analysis was conducted to estimate the network effects of the different treatment options.
We included 48 studies with 13,611 patients. Compared to no preparation, combined direct and indirect network estimates showed a relative risk (RR) for SSI of 0.57 (95% confidence interval [CI], 0.45-0.72) for MBP-OA, 0.68 (95% CI, 0.49-0.95) for OA, and 1.05 (95% CI, 0.87-1.26) for MBP. The RR for MBP-OA compared to OA was 0.84 (95% CI, 0.60-1.19); in sensitivity analysis of mainly laparoscopic procedures this effect of MBP-OA was more profound (RR, 0.56; 95% CI, 0.31-0.99).
This network meta-analysis of RCTs finds that both mechanical bowel preparation with oral antibiotics and oral antibiotics alone are comparably effective in the prevention of SSI. The evidence is uncertain about the relative benefit of MBP-OA compared to OA alone. Therefore, it seems justified to use either of the 2 for the prevention of SSI in colorectal surgery.
比较不同肠道准备方法对择期结直肠手术患者手术部位感染（SSI）、吻合口漏（AL）发生率及死亡率的影响。
近期指南建议采用机械肠道准备联合口服抗生素（MBP - OA）预防结直肠手术中的SSI。近期试验表明单独口服抗生素（OA）可能就足够了。
检索了从创刊至2021年8月10日的PubMed、MEDLINE和Embase数据库。我们纳入了比较多种肠道准备方法（机械肠道准备[MBP]、OA、MBP - OA或不进行准备）在SSI发生率、AL发生率和死亡率等临床结局方面的随机对照试验（RCT）。进行了频率学派随机效应网络荟萃分析以估计不同治疗方案的网络效应。
我们纳入了48项研究，共13611例患者。与不进行准备相比，直接和间接网络联合估计显示，MBP - OA组SSI的相对风险（RR）为0.57（95%置信区间[CI]，0.45 - 0.72），OA组为0.68（95%CI，0.49 - 0.95），MBP组为1.05（95%CI，0.87 - 1.26）。MBP - OA组与OA组相比的RR为0.84（95%CI，0.60 - 1.19）；在主要为腹腔镜手术的敏感性分析中，MBP - OA的这种效果更显著（RR，0.56；95%CI，0.31 - 0.99）。
这项RCT的网络荟萃分析发现，机械肠道准备联合口服抗生素和单独口服抗生素在预防SSI方面效果相当。关于MBP - OA与单独OA相比的相对益处，证据尚不确定。因此，在结直肠手术中使用这两种方法中的任何一种来预防SSI似乎都是合理的。
