In minimally invasive surgery, the debate continues over whether or not mechanical and oral antibiotic bowel preparation is more effective than preoperative oral antibiotics alone. This research aimed to examine the progression of infection rates at surgical sites in relation to the evolution of bowel preparation modalities for laparoscopic colorectal procedures in the United States. This is a historical study with a retrospective approach. The information used in this research came from the National Surgical Quality Improvement Program database maintained by the American College of Surgeons. Patients over the age of 18 who had planned colorectal surgery and disclosed their mode of bowel preparation were considered. Primary outcomes included comparing surgical site infection rates between patients with colon cancer, inflammatory bowel disease (IBD), and diverticular disease who underwent bowel preparation with oral antibiotics versus patients who underwent bowel preparation with mechanical means plus oral antibiotics. Those who had rectal procedures were studied independently. The study included data from 30,939 patients in total. Rectal resections were performed on 12,417 of them (40%). The use of combined mechanical and oral antibiotic bowel preparation increased from 29.3% in 2012 to 64.0% in 2018; P<0.0001 throughout the 7-year study period, at the expense of no preparation and mechanical bowel preparation alone. Oral antibiotics use also rose significantly, from 2.3% in 2012 to 5.5% in 2018, p<0.0001. Patients with colon cancer who only used oral antibiotics had a higher rate of superficial surgical site infection (1.9 % vs. 1.1 %; P=0.043) than those who used both mechanical and oral antibiotic bowel preparation. Infection rates at the surgical site, whether superficial, deep, or in an organ space, were comparable between the groups undergoing colon surgery (cancer, IBD, and diverticular disease). Deep surgical site infection was more common in patients with rectal cancer who were given oral antibiotics (0.9% vs. 0.1%; P=0.004). When comparing other types of rectal surgery, however, no significant differences were found in the rates of infection at the surgical site at any depth. The analysis was conducted retroactively, which was a weakness of this study. This study showed that during the study period, the use of both mechanical and oral antibiotic bowel preparation became increasingly common. Since the rates of surgical site infection are similar from a clinical relevance perspective among most comparative groups, one must question the practice of routinely adding mechanical bowel preparation to oral antibiotics alone in all patients prior to minimally invasive colorectal surgery.
Source: journals.lww.com/dcrjournal/Abstract/2022/09000/Oral_Antibiotics_Bowel_Preparation_Without.12.aspx
