The intersection of tumor location and combined bowel preparation: Utilization differs but anastomotic leak risk reduction does not.
Aged
Anastomotic Leak
/ prevention & control
Anti-Bacterial Agents
/ administration & dosage
Antibiotic Prophylaxis
/ methods
Colectomy
/ methods
Colonic Neoplasms
/ pathology
Elective Surgical Procedures
/ methods
Female
Follow-Up Studies
Humans
Male
Middle Aged
Preoperative Care
Prognosis
Retrospective Studies
Risk Reduction Behavior
NSQIP
bowel preparation
colectomy
proctectomy
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
28
06
2020
revised:
16
08
2020
accepted:
05
09
2020
pubmed:
2
10
2020
medline:
12
1
2021
entrez:
1
10
2020
Statut:
ppublish
Résumé
Whether bowel preparation utilization rates or effectiveness varies based on tumor location is unknown. The 2012-2016 American College of Surgeons National Surgical Quality Improvement Program Colectomy Targeted participant user file was queried for patients undergoing elective colorectal resection for cancer. Bowel preparation was classified as combined, mechanical bowel preparation alone, oral antibiotic alone, or none. Cochran-Armitage tests were used for trend analysis. Multivariable analyses stratified by tumor location were performed for the outcome of anastomotic leak. An additional multivariable model including all tumor locations assessed for interaction between bowel preparation and tumor location on an anastomotic leak. A total of 29,739 operations were included and the anastomotic leak rate was 1.9% with combined preparation versus 4.0% without preparation. Combined bowel preparation utilization increased over time as tumor location became more distal (both p < .0001). However, the adjusted effect of combined bowel preparation on anastomotic leak risk reduction did not differ by individual tumor location or across all tumor locations (p = .43 for interaction). Though the utilization rate of combined bowel preparation increased as tumor location became more distal, its risk-reducing effect remained similar. Quality improvement initiatives should focus on increased utilization of combined bowel preparation with an emphasis on tumors in the ascending colon.
Sections du résumé
BACKGROUND AND OBJECTIVE
OBJECTIVE
Whether bowel preparation utilization rates or effectiveness varies based on tumor location is unknown.
METHODS
METHODS
The 2012-2016 American College of Surgeons National Surgical Quality Improvement Program Colectomy Targeted participant user file was queried for patients undergoing elective colorectal resection for cancer. Bowel preparation was classified as combined, mechanical bowel preparation alone, oral antibiotic alone, or none. Cochran-Armitage tests were used for trend analysis. Multivariable analyses stratified by tumor location were performed for the outcome of anastomotic leak. An additional multivariable model including all tumor locations assessed for interaction between bowel preparation and tumor location on an anastomotic leak.
RESULTS
RESULTS
A total of 29,739 operations were included and the anastomotic leak rate was 1.9% with combined preparation versus 4.0% without preparation. Combined bowel preparation utilization increased over time as tumor location became more distal (both p < .0001). However, the adjusted effect of combined bowel preparation on anastomotic leak risk reduction did not differ by individual tumor location or across all tumor locations (p = .43 for interaction).
CONCLUSION
CONCLUSIONS
Though the utilization rate of combined bowel preparation increased as tumor location became more distal, its risk-reducing effect remained similar. Quality improvement initiatives should focus on increased utilization of combined bowel preparation with an emphasis on tumors in the ascending colon.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
261-270Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
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