A statewide assessment of surgical site infection following colectomy

The role of oral antibiotics

Michael J. Englesbe, Linda Brooks, James Kubus, Martin Luchtefeld, James Lynch, Anthony Senagore, John C. Eggenberger, Vic Velanovich, Darrell A. Campbell

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Objective: To determine the utility of adding oral nonabsorbable antibiotics to the bowel prep prior to elective colon surgery. Summary Background Data: Bowel preparation prior to colectomy remains controversial. We hypothesized that mechanical bowel preparation with oral antibiotics (compared with without) was associated with lower rates of surgical site infection (SSI). Methods: Twenty-four Michigan hospitals participated in the Michigan Surgical Quality Collaborative-Colectomy Best Practices Project. Standard perioperative data, bowel preparation process measures, and Clostridium difficile colitis outcomes were prospectively collected. Among patients receiving mechanical bowel preparation, a logistic regression model generated a propensity score that allowed us to match cases differing only in whether or not they had received oral antibiotics. Results: Overall, 2011 elective colectomies were performed over 16 months. Mechanical bowel prep without oral antibiotics was administered to 49.6% of patients, whereas 36.4% received a mechanical prep and oral antibiotics. Propensity analysis created 370 paired cases (differing only in receiving oral antibiotics). Patients receiving oral antibiotics were less likely to have any SSI (4.5% vs. 11.8%, P = 0.0001), to have an organ space infection (1.8% vs. 4.2%, P = 0.044) and to have a superficial SSI (2.6% vs. 7.6%, P = 0.001). Patients receiving bowel prep with oral antibiotics were also less likely to have a prolonged ileus (3.9% vs. 8.6%, P = 0.011) and had similar rates of C. difficile colitis (1.3% vs. 1.8%, P = 0.58). Conclusions: Most patients in Michigan receive mechanical bowel preparation prior to elective colectomy. Oral antibiotics may reduce the incidence of SSI.

Original languageEnglish (US)
Pages (from-to)514-519
Number of pages6
JournalAnnals of Surgery
Volume252
Issue number3
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Surgical Wound Infection
Colectomy
Anti-Bacterial Agents
Clostridium difficile
Colitis
Logistic Models
Propensity Score
Process Assessment (Health Care)
Ileus
Practice Guidelines
Colon

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Englesbe, M. J., Brooks, L., Kubus, J., Luchtefeld, M., Lynch, J., Senagore, A., ... Campbell, D. A. (2010). A statewide assessment of surgical site infection following colectomy: The role of oral antibiotics. Annals of Surgery, 252(3), 514-519. https://doi.org/10.1097/SLA.0b013e3181f244f8

A statewide assessment of surgical site infection following colectomy : The role of oral antibiotics. / Englesbe, Michael J.; Brooks, Linda; Kubus, James; Luchtefeld, Martin; Lynch, James; Senagore, Anthony; Eggenberger, John C.; Velanovich, Vic; Campbell, Darrell A.

In: Annals of Surgery, Vol. 252, No. 3, 2010, p. 514-519.

Research output: Contribution to journalArticle

Englesbe, MJ, Brooks, L, Kubus, J, Luchtefeld, M, Lynch, J, Senagore, A, Eggenberger, JC, Velanovich, V & Campbell, DA 2010, 'A statewide assessment of surgical site infection following colectomy: The role of oral antibiotics', Annals of Surgery, vol. 252, no. 3, pp. 514-519. https://doi.org/10.1097/SLA.0b013e3181f244f8
Englesbe, Michael J. ; Brooks, Linda ; Kubus, James ; Luchtefeld, Martin ; Lynch, James ; Senagore, Anthony ; Eggenberger, John C. ; Velanovich, Vic ; Campbell, Darrell A. / A statewide assessment of surgical site infection following colectomy : The role of oral antibiotics. In: Annals of Surgery. 2010 ; Vol. 252, No. 3. pp. 514-519.
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abstract = "Objective: To determine the utility of adding oral nonabsorbable antibiotics to the bowel prep prior to elective colon surgery. Summary Background Data: Bowel preparation prior to colectomy remains controversial. We hypothesized that mechanical bowel preparation with oral antibiotics (compared with without) was associated with lower rates of surgical site infection (SSI). Methods: Twenty-four Michigan hospitals participated in the Michigan Surgical Quality Collaborative-Colectomy Best Practices Project. Standard perioperative data, bowel preparation process measures, and Clostridium difficile colitis outcomes were prospectively collected. Among patients receiving mechanical bowel preparation, a logistic regression model generated a propensity score that allowed us to match cases differing only in whether or not they had received oral antibiotics. Results: Overall, 2011 elective colectomies were performed over 16 months. Mechanical bowel prep without oral antibiotics was administered to 49.6{\%} of patients, whereas 36.4{\%} received a mechanical prep and oral antibiotics. Propensity analysis created 370 paired cases (differing only in receiving oral antibiotics). Patients receiving oral antibiotics were less likely to have any SSI (4.5{\%} vs. 11.8{\%}, P = 0.0001), to have an organ space infection (1.8{\%} vs. 4.2{\%}, P = 0.044) and to have a superficial SSI (2.6{\%} vs. 7.6{\%}, P = 0.001). Patients receiving bowel prep with oral antibiotics were also less likely to have a prolonged ileus (3.9{\%} vs. 8.6{\%}, P = 0.011) and had similar rates of C. difficile colitis (1.3{\%} vs. 1.8{\%}, P = 0.58). Conclusions: Most patients in Michigan receive mechanical bowel preparation prior to elective colectomy. Oral antibiotics may reduce the incidence of SSI.",
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