Effect of preoperative oral antibiotics in combination with mechanical bowel preparation on inflammatory response and short‐term outcomes following left‐sided colonic and rectal resections

Golder, A.M. , Steele, C.W. , Conn, D., Mackay, G.J., McMillan, D.C. , Horgan, P.G. , Roxburgh, C.S. and McSorley, S.T. (2019) Effect of preoperative oral antibiotics in combination with mechanical bowel preparation on inflammatory response and short‐term outcomes following left‐sided colonic and rectal resections. BJS Open, 3(6), pp. 830-839. (doi: 10.1002/bjs5.50224) (PMID:31832590) (PMCID:PMC6887908)

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Abstract

Background: Preoperative oral antibiotics in addition to intravenous antibiotics and mechanical bowel preparation (MBP) may influence the gut microbiome and reduce both the postoperative systemic inflammatory response to surgery and postoperative infective complications following colorectal resection. This propensity score‐matched study compared outcomes of patients undergoing left‐sided colonic or rectal resection with or without a combination of oral antibiotics and MBP. Methods: The addition of oral antibiotics and MBP to prophylactic intravenous antibiotics in left‐sided colonic and rectal resections was introduced in 2015–2016 at a single institution. Propensity score matching was undertaken to compare the effects of oral antibiotics plus MBP versus neither oral antibiotics nor MBP on the postoperative systemic inflammatory response and short‐term outcomes in patients undergoing left‐sided colonic or rectal resection between 2013 and 2018. Results: Of 396 patients who had propensity score matching for host, anaesthetic and operative factors, 204 matched patients were identified. The addition of oral antibiotics and MBP was associated with a significantly reduced postoperative inflammatory response (reduced postoperative Glasgow Prognostic Score) on day 3 (odds ratio (OR) 0·66, 95 per cent c.i. 0·44 to 0·99; P  = 0·013) and day 4 (OR 0·46, 0·30 to 0·71; P  = 0·001). Significantly reduced overall complications (OR 0·31, 0·17 to 0·56; P  < 0·001), infective complications (OR 0·41, 0·22 to 0·77; P  = 0·011), surgical‐site infection (OR 0·37, 0·17 to 0·83; P  = 0·024) and postoperative length of hospital stay (median 7 days versus 8 days in patients who had intravenous antibiotics alone; P  = 0·050) were also observed. Conclusion: Preoperative oral antibiotics and MBP in addition to prophylactic intravenous antibiotics were associated with a reduction in the postoperative systemic inflammatory response and postoperative complications in patients undergoing resectional left‐sided colonic or rectal surgery.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Horgan, Professor Paul and Mackay, Mr Graham and Golder, Mr Allan and McSorley, Dr Stephen and McMillan, Professor Donald and Steele, Dr Colin and Roxburgh, Dr Campbell
Authors: Golder, A.M., Steele, C.W., Conn, D., Mackay, G.J., McMillan, D.C., Horgan, P.G., Roxburgh, C.S., and McSorley, S.T.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:BJS Open
Publisher:Wiley
ISSN:2474-9842
ISSN (Online):2474-9842
Published Online:16 October 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in BJS Open 3(6): 830-839
Publisher Policy:Reproduced under a Creative Commons License

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