C.E. Paterson1, A. Nikolic2, T. Glyn2, T. Eglington2, P. Singh1, A.G. Hill1 1South Auckland Clinical School, Auckland, AUCKLAND, New Zealand 2Department of Surgery, Christchurch Hospital, Department Of Surgery, Christchurch, CANTERBURY, New Zealand
Introduction: Postoperative infections remain common in elective colorectal surgery. Perioperative probiotics/synbiotics have been investigated as a strategy to optimise the intestinal microbiota and reduce postoperative infections. The aim of this study was to conduct an updated systematic review and meta-analysis on the efficacy of perioperative probiotics/synbiotics on postoperative infection rates following elective colorectal surgery.
Methods: Six databases were searched on 7th February 2023 in accordance with the PRISMA 2020 guidelines (PROSPERO: CRD420233392754). Inclusion criteria was randomized controlled trials comparing perioperative probiotics or synbiotics in colorectal resection for malignant or benign disease in patients >18 years, reporting data on infectious complications within 30 days of surgery. Exclusion criteria was patients undergoing acute colorectal resection, non-randomized controlled trials, prebiotics alone used as the intervention or control. The primary outcome was total postoperative infection rates within 30 days of elective colorectal surgery.
Results: Twenty-eight randomized controlled trials involving 2,686 participants demonstrated an association between probiotics/synbiotics and reduced rates of total postoperative infections within 30 days of elective colorectal surgery (RR 0.55, 95% CI 0.41-0.74, p<0.0001). Further reductions in rates were shown in pneumonia (RR 0.39, 95% CI 0.26-0.59, p<0.0001), urinary tract infections (RR 0.49, 95% CI 0.29-0.82, p=0.007), surgical site infections (RR 0.60, 95% CI 0.48-0.75, p<0.0001), intra-abdominal abscesses (RR 0.52, 95% CI 0.30-0.89), and line infections (RR 0.32, 95% CI 0.15-0.69, p=0.003).
Conclusion: Perioperative probiotics/synbiotics are associated with an almost halved total postoperative infection rate within 30 days of elective colorectal surgery. Conclusions from this systematic review are limited by heterogeneity among patient cohorts, variability in intervention regimens, and discrepancies in the diagnoses of postoperative infections. Further investigation into optimal regimens and the confounding effect of modern colorectal surgical practice is essential prior to implementation into clinical practice.