Chemical Bowel Preparation Exerts an Independent Preventive Effect Against Surgical Site Infection Following Elective Laparoscopic Colorectal Surgery

Abstract

Abstract Purpose: We investigated the clinical value of mechanical and chemical bowel preparations (MBP, CBP) for preventing surgical site infection (SSI) in patients undergoing elective laparoscopic colorectal surgery. Methods: This retrospective cohort study included 475 patients who underwent elective laparoscopic colorectal surgery between January 2018 and March 2022. CBP was introduced in January 2021. CBP included kanamycin (1 g) and metronidazole (1 g) two times a day, the day before surgery. In some cases, MBP was omitted in patients who planned to undergo right-sided colectomy, those with tumor obstruction, and those with poor general condition, depending on the physician’s judgment. The endpoints were primarily the overall incidence of SSI, and secondarily incisional SSI, organ-space SSI, culture from the surgical site, and postoperative hospital stay. Results: In total, 136 patients underwent CBP. MBP was omitted in 53 patients. Overall, SSI occurred in 80 patients (16.8%), including 61 cases of incisional SSI (12.8%) and 36 cases of organ-space SSI (7.6%). Multivariate logistic regression revealed that CBP exerted an independent preventive effect on overall and incisional SSI, whereas MBP did not. Levels of Bacteroides species at the surgical site were significantly lower in the CBP group than in the non-CBP group. Postoperative hospital stay was significantly longer in the incisional SSI group than in non-SSI group and was significantly longer in the organ-space SSI group than in the other groups.Conclusion: CBP, but not MBP, exerts an independent preventive effect on SSI, especially incisional SSI, in patients undergoing elective laparoscopic colorectal surgery.