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Transitioning to a Combination Mechanical and Oral Antibiotic Bowel Prep Is Associated With Reduced Postoperative Ileus and Length of Stay After Colorectal Resection
Daniel Herzig*, Fouad M. Attia, Kim C. Lu, Vassiliki L. Tsikitis, Brett C. Sheppard
Surgery, Oregon Health and Science University, Portland, OR
Introduction: The combination of mechanical and oral antibiotic bowel preparation has emerged as one of the most common quality improvement strategies to reduce surgical site infection after colorectal surgery. Recent reports suggest there may be additional benefits of lower anastomotic leak rate and postoperative ileus. We sought to determine if our rate of ileus has changed since initiating a transitio to combined oral and antibiotic bowel preparation in 2013.
Methods: Data from patients undergoing colorectal surgery at a tertiary-care academic medical center were prospectively collected as part of the ACS-NSQIP program. All patients having a colorectal resection from July 1, 2013 to June 30, 2015 were included. The primary endpoint was the presence of an ileus, defined within NSQIP and recorded as a discrete variable since 2012. Data regarding bowel preparation including mechanical only or combination of both mechanical and oral antibiotic, as well as length of stay were recorded in all cases. Bowel prep (combined mechanical-antibiotic/no combination) and length of stay (over/under average) compared with ileus (yes/no) were analyzed with 2x2 contingency table with statistical significance defined as p<0.05 using two-tailed Fisher’s exact test.
Results: A total of 188 colorectal resections were performed in the study period. Laparoscopic approach was used in 49% of patients. Ileus occurred in 17 (9%) of patients overall. With respect to bowel prep, ileus occurred in 9/142 patients (6.3%) with combined mechanical-oral antibiotic prep compared to 8/46 patients (17.4%) without combined prep (p=0.04). The average length of stay for all cases was 6 days. Above average length of stay was seen in 28/142 patients (19.7%) with combined mechanical-oral antibiotic prep compared to 32/46 patients (69.6%) without combined prep (p<0.001).
Conclusion: Transitioning to a combined mechanical and oral antibiotic bowel prep is associated with lower rates of postoperative ileus and shorter length of stay. Further analysis will be required to isolate confounding variables and define whether causation can be proven.
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