K. L. Carpenter1, F. Breckler2, B. W. Gray1,3 1Indiana University School Of Medicine,Department Of Surgery,Indianapolis, IN, USA 2Riley Hospital for Children,Department Of Pharmacy,Indianapolis, IN, USA 3Riley Hospital for Children,Section Of Pediatric Surgery,Indianapolis, IN, USA
Introduction:
There are no clear guidelines for the use of mechanical bowel prep and postoperative antibiotics in children undergoing elective colorectal pull-through surgery. Mechanical bowel prep in this patient population has not been demonstrated to provide benefit. The objective of this study was to determine whether preoperative mechanical bowel prep administration or duration of postoperative antibiotics impacted the rate of complications following elective pediatric pull-through surgery.
Methods:
Patients under 18 years who underwent a pull-through procedure between 2011 and 2017 at a single institution were retrospectively identified based on CPT code. Patient data included diagnosis, procedure, administration of mechanical bowel prep, and duration of perioperative IV antibiotics. Outcomes of interest included surgical site infections and anastomotic complications.
Results:
181 patients met inclusion criteria, of which 47.5% received mechanical bowel prep. Only one patient received oral antibiotics as part of the bowel prep regimen. There were three anastomotic complications overall, two leaks and one stricture. Neither administration of bowel prep (p=0.4983) nor duration of IV antibiotics (p=1.000) was associated with anastomotic complications. Table 1 shows the rates of infectious complications for each subgroup. The overall rate of complications was 13.3%. There was no significant difference in complication rate among those receiving mechanical bowel prep compared to those who did not (15.1% vs. 11.6%, p=0.48). When stratified by procedure type, administration of mechanical bowel prep in the anoplasty subgroup was associated with higher rates of wound infection (33.3% vs 3.3%, p=0.03). 111 patients (60%) received perioperative IV antibiotics for 24 hours or less. This group had similar rates of complications (14.4%) compared to those receiving IV antibiotics for longer than 24 hours (11.4%, p=0.56).
Conclusion:
Although mechanical bowel prep did not affect the overall complication rate for pull-through procedures, it was associated with more wound infections in those undergoing anoplasty. Duration of postoperative IV antibiotics was not significantly associated with the rate of wound and anastomotic complications. Further work should lead to a prospective study of bowel prep and perioperative antibiotics in this patient group.
