학술논문
Bowel preparation for elective colectomy in Crohn's disease: results from a global cohort study using the NSQIP database.
Document Type
Academic Journal
Author
Callado GY; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo City, São Paulo, Brazil.; de Almeida Leite RM; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo City, São Paulo, Brazil.; Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Araujo SEA; Staff Colorectal Surgeon and Medical Director, Oncology Division, Hospital Israelita Albert Einstein, São Paulo City, São Paulo, Brazil.; Barchi LC; Gastromed, Zilberstein Institute, São Paulo City, São Paulo, Brazil.; Seddiq W; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.; Correa IP; Faculdade de Medicina da Universidade São Francisco, Bragança Paulista, São Paulo, Brazil.; Junior UR; Gastrointestinal Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo City, São Paulo, Brazil.; Ricciardi R; Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Source
Publisher: Blackwell Science Ltd Country of Publication: England NLM ID: 100883611 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1463-1318 (Electronic) Linking ISSN: 14628910 NLM ISO Abbreviation: Colorectal Dis Subsets: MEDLINE
Subject
Language
English
Abstract
Aim: The role of bowel preparation before colectomy in Crohn's disease patients remains controversial. This retrospective analysis of a prospective cohort study aimed to investigate the clinical outcomes associated with mechanical and antibiotic colon preparation in patients diagnosed with Crohn's disease undergoing elective colectomy.
Method: Data were collected from the American College of Surgeons National Surgical Quality Improvement Program participant user files from 2016 to 2021. A total of 6244 patients with Crohn's disease who underwent elective colectomy were included. The patients were categorized into two groups: those who received combined colon preparation (mechanical and antibiotic) and those who did not receive any form of bowel preparation. The primary outcomes assessed were the rate of anastomotic leak and the occurrence of deep organ infection. Secondary outcomes included all-cause short-term mortality, clinical-related morbidity, ostomy creation, unplanned reoperation, operative time, hospital length of stay and ileus.
Results: Combined colon preparation was associated with significantly reduced risks of anastomotic leak (relative risk 0.73, 95% CI 0.56-0.95, P = 0.021) and deep organ infection (relative risk 0.68, 95% CI 0.56-0.83, P < 0.001). Additionally, patients who underwent colon preparation had lower rates of ostomy creation, shorter hospital stays and a decreased incidence of ileus. However, there was no significant difference in all-cause short-term mortality or the need for unplanned reoperation between the two groups.
Conclusion: This study shows that mechanical and antibiotic colon preparation may have clinical benefits for patients with Crohn's disease undergoing elective colectomy.
(© 2024 The Association of Coloproctology of Great Britain and Ireland.)
Method: Data were collected from the American College of Surgeons National Surgical Quality Improvement Program participant user files from 2016 to 2021. A total of 6244 patients with Crohn's disease who underwent elective colectomy were included. The patients were categorized into two groups: those who received combined colon preparation (mechanical and antibiotic) and those who did not receive any form of bowel preparation. The primary outcomes assessed were the rate of anastomotic leak and the occurrence of deep organ infection. Secondary outcomes included all-cause short-term mortality, clinical-related morbidity, ostomy creation, unplanned reoperation, operative time, hospital length of stay and ileus.
Results: Combined colon preparation was associated with significantly reduced risks of anastomotic leak (relative risk 0.73, 95% CI 0.56-0.95, P = 0.021) and deep organ infection (relative risk 0.68, 95% CI 0.56-0.83, P < 0.001). Additionally, patients who underwent colon preparation had lower rates of ostomy creation, shorter hospital stays and a decreased incidence of ileus. However, there was no significant difference in all-cause short-term mortality or the need for unplanned reoperation between the two groups.
Conclusion: This study shows that mechanical and antibiotic colon preparation may have clinical benefits for patients with Crohn's disease undergoing elective colectomy.
(© 2024 The Association of Coloproctology of Great Britain and Ireland.)