K. Zorbas1, A. Choudhry2, H. Ross1, D. Yu2, M. Philp1 1Temple University,Department Of Surgery/Lewis Katz School Of Medicine,Philadelpha, PA, USA 2Temple University,Lewis Katz School Of Medicine,Philadelpha, PA, USA
Introduction: Controversy exists regarding the impact of preoperative bowel preparation on patients undergoing colorectal surgery. This is due to previous research studies, which fail to demonstrate protective effects of mechanical bowel preparation (MBP) against postoperative complications. However, in recent studies, combination therapy with oral antibiotics (AB) and MBP seems to be beneficial for patients undergoing an elective colorectal operation. We aimed to determine the association between preoperative bowel preparation and postoperative anastomotic leak management. We hypothesized that patients experiencing anastomotic leaks following preoperative AB+MBP would require reoperation for leak management less frequently.
Methods: Patients with anastomotic leak after colorectal surgery were identified from the 2013 and 2014 Colectomy Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database and were employed for analysis. Every patient was assigned to one of four groups based on the type of preoperative preparation that had received [Mechanical Bowel Preparation and antibiotic (MBP/AB), Mechanical Bowel Preparation alone (MBP), Antibiotic use alone (OAB) and no-preparation (Nothing)]. First, descriptive statistics were used to cite preoperative patient’s characteristics (Table 1). The association between preoperative bowel preparation and postoperative anastomotic leak management was assessed using chi-square test.
Results:Of 1678 patients who had anastomotic leak after a colorectal resection, 695 had adequate information. Baseline characteristic were assessed and found that there were no statistically significant differences between the four groups in terms of age, gender and ASA score. However, we found a higher percentage of patients with Caucasian ancestry. A Chi-Square test of homogeneity was conducted and there was no statistically significant difference between proportion of re-operated patients in the four categories of bowel preparation and operative leak management; p= 0.303.
Conclusion:The implementation of mechanical bowel preparation and antibiotic use in patients who are going to undergo a colon resection does not influence the treatment of any possible anastomotic leakage.
