Bowel Preparation Is Associated with Reduced Morbidity in Elderly Patients Undergoing Elective Colectomy

Scott C. Dolejs, Michael J. Guzman, Alyssa D. Fajardo, Bruce Robb, Bryan Holcomb, Ben L. Zarzaur, Joshua A. Waters

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Bowel preparation in elderly patients is associated with physiologic derangements that may result in postoperative complications. The aim of this study is to determine the impact of bowel preparation on postoperative outcomes in elderly patients. Methods: Patients age 75 years and older who underwent elective colectomy were identified from the 2012–2014 American College of National Surgical Quality Improvement Program (ACS-NSQIP database). Patients were grouped into no bowel preparation, mechanical bowel preparation (MBP), oral antibiotic preparation (OABP), or combined MBP + OABP. Logistic regression modeling was conducted to calculate risk-adjusted 30-day outcomes. Results: There were 4829 patients included in the analysis. Morbidity was 34.3% in no bowel prep, 32.4% in MBP, 24.8% in OABP, and 24.6% in MBP + OABP groups (p < 0.001). The MBP + OABP group compared with no bowel prep was associated with reduced rates of anastomotic leak, ileus, superficial surgical site infection (SSI), organ space SSI, respiratory compromise, and reduced length of stay. There was no difference in the rate of acute kidney injury between the groups. Conclusion: MBP + OABP was associated with reduced morbidity compared with no bowel preparation in elderly patients undergoing elective colorectal resection. MBP alone was not associated with differences in outcomes compared with no bowel preparation. The use of MBP + OABP is safe and effective in elderly patients undergoing elective colectomy.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Nov 28 2016

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Colectomy
Anti-Bacterial Agents
Morbidity
Surgical Wound Infection
Anastomotic Leak
Ileus
Quality Improvement
Acute Kidney Injury
Length of Stay
Logistic Models
Databases

Keywords

  • Cathartics
  • Colectomy
  • Geriatrics
  • Postoperative complications

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Bowel Preparation Is Associated with Reduced Morbidity in Elderly Patients Undergoing Elective Colectomy. / Dolejs, Scott C.; Guzman, Michael J.; Fajardo, Alyssa D.; Robb, Bruce; Holcomb, Bryan; Zarzaur, Ben L.; Waters, Joshua A.

In: Journal of Gastrointestinal Surgery, 28.11.2016, p. 1-8.

Research output: Contribution to journalArticle

Dolejs, Scott C. ; Guzman, Michael J. ; Fajardo, Alyssa D. ; Robb, Bruce ; Holcomb, Bryan ; Zarzaur, Ben L. ; Waters, Joshua A. / Bowel Preparation Is Associated with Reduced Morbidity in Elderly Patients Undergoing Elective Colectomy. In: Journal of Gastrointestinal Surgery. 2016 ; pp. 1-8.
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abstract = "Background: Bowel preparation in elderly patients is associated with physiologic derangements that may result in postoperative complications. The aim of this study is to determine the impact of bowel preparation on postoperative outcomes in elderly patients. Methods: Patients age 75 years and older who underwent elective colectomy were identified from the 2012–2014 American College of National Surgical Quality Improvement Program (ACS-NSQIP database). Patients were grouped into no bowel preparation, mechanical bowel preparation (MBP), oral antibiotic preparation (OABP), or combined MBP + OABP. Logistic regression modeling was conducted to calculate risk-adjusted 30-day outcomes. Results: There were 4829 patients included in the analysis. Morbidity was 34.3{\%} in no bowel prep, 32.4{\%} in MBP, 24.8{\%} in OABP, and 24.6{\%} in MBP + OABP groups (p < 0.001). The MBP + OABP group compared with no bowel prep was associated with reduced rates of anastomotic leak, ileus, superficial surgical site infection (SSI), organ space SSI, respiratory compromise, and reduced length of stay. There was no difference in the rate of acute kidney injury between the groups. Conclusion: MBP + OABP was associated with reduced morbidity compared with no bowel preparation in elderly patients undergoing elective colorectal resection. MBP alone was not associated with differences in outcomes compared with no bowel preparation. The use of MBP + OABP is safe and effective in elderly patients undergoing elective colectomy.",
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