Tagged mechanical bowel preparation

Guidance Note: Mechanical Bowel Preparation recommendations

For areas of the ERAS protocol where a strong recommendation does not appear in the literature and where clearer guidance would facilitate ERAS implementation, the Collaborative brings together a working group of practitioners with the aim of developing stronger guidance. The Collaborative is pleased to release its first Guidance Note, which provides recommendations on the use of mechanical bowel preparation for colorectal procedures.

This guidance document was developed after consultation with the British Columbia ERAS Collaborative, including its Co-Chairs and 11 participating hospital teams, and the British Columbia Colorectal Surgeons Network/UBC Section of Colorectal Surgery. This guidance document has been approved by the ERAS Collaborative’s Advisory Panel, which includes surgery, anesthesia, and nursing representatives from across BC’s regional health authorities. Thank you to Dr. Ahmer Karimuddin for his leadership in developing this guidance note.

Click here for the guidance on mechanical bowel preparation, which can also be found in the ‘Guidance Notes’ section under the Tools tab.

 

Research: Outcomes of Bowel Preparation in Colon Surgery

Nationwide Analysis of Outcomes of Bowel Preparation in Colon Surgery

Moghadamyeghaneh Z, Hanna M, Carmichael J, et al. (May 2015)

Background

There are limited data comparing the outcomes of preoperative oral antibiotic bowel preparation (OBP) and mechanical bowel preparation (MBP) in colorectal surgery. We sought to identify the relationship between preoperative bowel preparations (BP) and postoperative complications in colon cancer surgery.

Study Design

The NSQIP database was used to examine the clinical data of colon cancer patients undergoing scheduled colon resection during 2012 to 2013. Multivariate regression analysis was performed to identify correlations between BP and postoperative complications.

Results

We evaluated a total of 5,021 patients who underwent elective colon resection. Of these, 44.8% had only MBP, 2.3% had only OBP, 27.6% had both MBP and OBP, and 25.3% of patients did not have any type of BP. In multivariate analysis of data, MBP and OBP were not associated with decreased risk of postoperative complications in right side (adjusted odds ratio [AOR] 0.80, 0.30, p = 0.08, 0.10, respectively) or left side colon resections (AOR 1.02, 0.68, p = 0.81, 0.24, respectively). However, the combination of MBP and OBP before left side colon resections resulted in a significantly decreased risk of overall morbidity (AOR 0.63, p < 0.01), superficial surgical site infection (AOR 0.31, p < 0.01), anastomosis leakage (AOR 0.44, p < 0.01), and intra-abdominal infections (AOR 0.44, p < 0.01).

Conclusions

Our analysis revealed that solitary mechanical bowel preparation and solitary oral bowel preparation had no significant effects on major postoperative complications after colon cancer resection. However, a combination of mechanical and oral antibiotic preparations showed a significant decrease in postoperative morbidity.

Abbreviations and Acronyms:

AOR (adjusted odds ratio), BP (bowel preparation), MBP (mechanical bowel preparation), OBP (oral antibiotic bowel preparation), SSI (surgical site infection)

J Am Coll Surgeons. May 2015;220(5):912–920.