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Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection : an international, multi-centre, prospective audit

Mangell, Peter LU (2018) In Colorectal Disease 20 Suppl 6. p.15-32
Abstract

INTRODUCTION: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP).

METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic... (More)

INTRODUCTION: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP).

METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.

RESULTS: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30-0.92, P = 0.02) but MBP was not (OR 0.92, 0.63-1.36, P = 0.69) compared to NBP.

CONCLUSION: This non-randomised study adds 'real-world', contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice.

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Please use this url to cite or link to this publication:
author
contributor
LU and LU
author collaboration
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Aged, Anastomotic Leak/etiology, Anti-Bacterial Agents/administration & dosage, Cathartics/administration & dosage, Colectomy/adverse effects, Drug Therapy, Combination, Female, Humans, Male, Medical Audit, Middle Aged, Preoperative Care/methods, Prospective Studies, Risk Factors
in
Colorectal Disease
volume
20 Suppl 6
pages
15 - 32
publisher
Wiley-Blackwell
external identifiers
  • pmid:30255646
  • scopus:85053817875
ISSN
1462-8910
DOI
10.1111/codi.14362
language
English
LU publication?
no
additional info
Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.
id
d46dec5b-4b78-4716-9d43-a8101de7ac21
date added to LUP
2021-12-29 12:00:33
date last changed
2024-06-01 23:06:08
@article{d46dec5b-4b78-4716-9d43-a8101de7ac21,
  abstract     = {{<p>INTRODUCTION: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP).</p><p>METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.</p><p>RESULTS: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30-0.92, P = 0.02) but MBP was not (OR 0.92, 0.63-1.36, P = 0.69) compared to NBP.</p><p>CONCLUSION: This non-randomised study adds 'real-world', contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice.</p>}},
  author       = {{Mangell, Peter}},
  issn         = {{1462-8910}},
  keywords     = {{Aged; Anastomotic Leak/etiology; Anti-Bacterial Agents/administration & dosage; Cathartics/administration & dosage; Colectomy/adverse effects; Drug Therapy, Combination; Female; Humans; Male; Medical Audit; Middle Aged; Preoperative Care/methods; Prospective Studies; Risk Factors}},
  language     = {{eng}},
  pages        = {{15--32}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Colorectal Disease}},
  title        = {{Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection : an international, multi-centre, prospective audit}},
  url          = {{http://dx.doi.org/10.1111/codi.14362}},
  doi          = {{10.1111/codi.14362}},
  volume       = {{20 Suppl 6}},
  year         = {{2018}},
}