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

• Published in: BJS open 2019-12, Vol.3 (6), p.830-839
• Main Authors: Golder, A. M., Steele, C. W., Conn, D., MacKay, G. J., McMillan, D. C., Horgan, P. G., Roxburgh, C. S., McSorley, S. T.
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Administration, Oral; Aged; Anesthesia; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis - methods; Antibiotics; Bias; Cathartics - administration & dosage; Colectomy - adverse effects; Colorectal cancer; Colorectal surgery; Elective Surgical Procedures - adverse effects; Female; Hospitals; Humans; Infections; Longitudinal Studies; Lower GI; Male; Middle Aged; Morbidity; Mortality; Original; Patients; Preoperative Care - methods; Proctectomy - adverse effects; Studies; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control; Systemic Inflammatory Response Syndrome - epidemiology; Systemic Inflammatory Response Syndrome - etiology; Systemic Inflammatory Response Syndrome - prevention & control
• ISSN: 2474-9842; 2474-9842
• DOI: 10.1002/bjs5.50224

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