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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N2 - 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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