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USE OF PRE-OPERATIVE ANTIBIOTICS IS ASSOCIATED WITH A LOWER RATE OF ILEUS UNRELATED TO ANASTAMOTIC LEAK IN PATIENTS WITH COLORECTAL CANCER
Juliane Y. Cruz*1, Elyse LeeVan2, Howard S. Kaufman2,3, Aaron G. Lewis2,4
1Surgery/GME, Huntington Hospital, Los Angeles, CA; 2Surgery, Huntington Hospital, Pasadena, CA; 3Huntington Medical Research Institutes, Pasadena, CA; 4Surgical Oncology, City of Hope, Duarte, CA
Background
Pre-operative oral antibiotics (POAP) in association with mechanical bowel preparation have been associated with reduced surgical site infections and reduced anastamotic leaks in patients undergoing elective colectomy. Ileus is a known complication after colectomy that can lead to increased length of stay (LOS). Although mechanical bowel preparation in conjunction with POAP has been previously found to reduce ileus, it is not certain whether POAP alone has an effect on ileus.
Methods
A query of the 2015 targeted colectomy data of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant User Files (PUF) was used to identify patients undergoing colectomies for cancer. A step-wise regression was used to identify predictors of ileus. Variables used to match the patients included, age, gender, type of colonic resection, use of steroids, chemotherapy, prealbumin, tobacco use, laparoscopy, elective status of operation, use of mechanical bowel preparation, white blood cell count, frailty, and presence of an ostomy. Nearest-neighbor propensity score matching (PSM) was performed to match patients that did and did not receive POAP.
Results
Before PSM, a total of 7,288 patients with colorectal cancer were identified, of which 2,956 (40.6%) had recieved POAP. Laparoscopy was performed in 65.3% vs 57.6%, mechanical bowel preparation was used in 91.1% vs. 48.1%, and elective surgery was performed in 88.5% vs. 71.7% of patients with and without use of POAP, respectively (all statistically significant). The rate of ileus was 11.9% vs. 17.4% in patients that received POAP and those who did not, respectively (p=0.00). After PSM, a total of 1,919 patients were included in each group that did and did not receive POAP prior to colectomy. Ileus was observed in 12.1% of patients who received POAP and in 15.0% of patients who did not (p=0.01). An anastamotic leak rate of 2.1% vs. 3.0 % was observed in the those patients that did and did not receive POAP, respectively (p=0.08). In patients who did not have a leak, ileus was observed was in 10.8% vs. 13.4% in patients with and without the use of POAP, respectively (p<.01).
Conclusion
Use of POAP is associated with reduced ileus rates after colorectal surgery in cancer patients. This relationship is independent of the presence of an anastamotic leak. POAP should be considered for enhanced recovery pathways.
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