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Session: ePoster: Quality and Cost 2 (Sun225)

EP527 - Is Antibiotic Bowel Preparation Alone Sufficient to Improve Outcomes Following Colon Resection?

Sunday, May 11, 2025
2:52 PM – 2:57 PM PT
Location: Monitor 9, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • DP

    Daniel Peyser, MD

    Colorectal Surgery Fellow
    Indiana University
    Indianapolis, IN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Matthew Laskovy, DO

    Colorectal Surgery Fellow
    Indiana University/Franciscan Health
    Camby, IN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • TR

    Tobi Reidy, DO

    Colon and Rectal Surgeon
    Indiana Colon and Rectal Specialists
    Indianapolis, Indiana, United States

    Disclosure information not submitted.

  • FL

    Frederick R. Lane, MD

    Colon and Rectal Surgeon
    Indiana Colon and Rectal Specialists
    Indianapolis, Indiana, United States

    Disclosure information not submitted.

  • DM

    Dipen Maun, MD

    Program Director
    Indiana Colon and Rectal Specialists
    Indianapolis, Indiana, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Scott Dolejs, MD, MSc

    Colon and Rectal Surgeon
    Indiana Colon and Rectal Specialists
    Indianapolis, IN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Daniel Peyser, MD: This individual has no financial relationships with ineligible companies.
Matthew Laskovy, DO: This individual has no financial relationships with ineligible companies.
Scott Dolejs, MD, MSc: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Mechanical bowel preparation (MBP) and oral antibiotic bowel preparation (ABP) have been used in colorectal surgery as a method of reducing colonic bacterial load to minimize postoperative infections and leaks. Historically, there has been debate about the optimal (if any) bowel preparation with recommendations frequently changing. Current guidelines from the American Society of Colon and Rectal Surgeons recommend MBP with ABP for elective colorectal resections. However, few studies have directly compared ABP alone to the combination of MBP and ABP. In this study, we compare postoperative outcomes in patients undergoing colon resection with oral antibiotic bowel preparation to those with both mechanical bowel preparation and oral antibiotics.

Methods/Interventions: A query of the National Surgery Quality Improvement Program (NSQIP) database was performed for patients that underwent colon resection with ABP alone or ABP + MBP between 2012 – 2021 and a retrospective cohort analysis was performed using 1:1 propensity score matching to compare patients. Additionally, a stratified analysis was performed looking at left-sided resections and right-sided resections. The two groups were matched based on patient demographics and perioperative characteristics. The primary outcome was rates of anastomotic leak, surgical site infections (SSI), 30-day mortality, 30-day morbidity, and 30-day serious morbidity.

Results/Outcomes: A total of 153,579 patients undergoing surgery during our study period met inclusion criteria. After 1:1 propensity score matching, a total of 29,156 patients were included; 14,578 patients in each group (ABP and ABP+MBP). When comparing ABP vs ABP+MBP, rates of anastomotic leak (2.8% vs 2.3%, p=0.005), superficial surgical site infection (3.0% vs 2.3%, p=0.0002), organ space SSI (4.6% vs 3.9%, p=0.002), 30-day morbidity (25.5% vs 22.1%, p< 0.001), and 30-day serious morbidity (13.8% vs 12.0%, p< 0.001) were higher in the ABP alone group compared to the ABP+MBP group.
Amongst right-sided resections (n = 8,602), a significantly higher rate of 30-day morbidity (24.3% vs 21.7%, p=0.004) and organ space SSI (4.0% vs 3.2%, p=0.04) was seen in right-sided resections undergoing ABP alone compared to ABP+MBP was found. There was no statistically significant difference in leak or serious morbidity.
In left-sided resections (n = 20,554), a significantly higher rate of 30-day morbidity (26.0% vs 23.4%, p< 0.001), 30-day serious morbidity (14.2% vs 12.7%, p=0.002), superficial SSI (3.1% vs 2.4%, p=0.002), and organ space SSI (4.9% vs 4.2%, p=0.03) was seen in left-sided resections undergoing ABP only compared to ABP+MBP. There was no statistically significantly higher rates of anastomotic leak.

Conclusion/Discussion: In this analysis of patients undergoing colon resection, combined mechanical bowel preparation and oral antibiotic bowel preparation was associated with lower rates of superficial SSI, organ space infection, anastomotic leak, and 30-day morbidity compared to oral antibiotic bowel preparation alone. This combination should be considered the standard of care.