Mechanical bowel preparations not supported in elective colo-rectal surgeries with anastomosis: A retrospective study

Abstract

Objective To analyze the risk and benefit of bowel preparations in elective colo-rectal surgery. Background Mechanical bowel preparations (MBPs) have been popularized in colo-rectal surgery since studies in the 1970s, but recent data has called their use into question and examined complication rates between patients with and without bowel preparations. Methods A retrospective case-review was performed consisting of 1237 elective colo-rectal surgeries performed by two surgeons between 2008 and 2021. Patients received either a MBP, a mechanical bowel preparation with oral antibiotics (OAMBP), oral antibiotics alone (OA), or no bowel preparation; some patients across all categories received an enema. Results Bowel preparations combined (MBP and OAMBP) totaled 436 patients and showed no statistically significant difference ( P > .05) in primary outcomes of wound infection and anastomotic leak when compared to the 636 patients without a bowel preparation and 165 patients with OA. The analysis controlled for comorbidities and presence of enema. Of secondary outcomes, urinary tract infections (UTIs) were significantly more common in patients who received a bowel preparation ( P = .047). All other outcomes showed no significant difference between groups, including complications on day of surgery; complications, readmission with and without surgery, and ileus formation within 30 days of surgery; sepsis; pneumonia; and length of stay (LOS). The presence of enemas did not have a statistically significant effect on outcomes. Conclusions This study’s data does not support the routine use of MBPs in elective colo-rectal surgery and draws into further question whether MBPs should remain standard of care.