Preoperative Oral Antibiotics Preparation is Associated With Improved 30-day Outcomes in Elective Colectomy for Ulcerative Colitis

• Published in: The American surgeon Vol. 91; no. 6; p. 954
• Main Authors: Li, Renxi, Kartiko, Susan
• Format: Journal Article
• Language: English
• Published: United States 01.06.2025
• Subjects: Administration, Oral; Adult; Aged; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis - methods; Colectomy - adverse effects; Colectomy - methods; Colitis, Ulcerative - surgery; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - methods; Female; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Preoperative Care - methods; Retrospective Studies; Treatment Outcome; colectomy; infection; wound; ulcerative colitis; oral antibiotics
• ISSN: 1555-9823
• DOI: 10.1177/00031348251323704

BackgroundUlcerative colitis (UC) is characterized by colonic involvement, where the 10-year risk of colectomy remains high at about 20%. The use of preoperative oral antibiotic preparation (OAP) in colectomy remains a subject of debate and there was limited evidence for UC patients. This study aimed to retrospectively investigate the relationship between OAP and 30-day outcomes following elective colectomy in UC patients using a multi-institutional national dataset.MethodsPatients with UC as the primary indication for colectomy were selected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2013 to 2022. Thirty-day postoperative outcomes were compared by multivariable logistic regression, where demographics, baseline characteristics, preoperative preparation, and operative approaches were adjusted.ResultsAmong 6075 patients who underwent elective colectomy for UC, 3193 (52.56%) of them received preoperative OAP. Patients with OAP had lower cardiac complications (aOR = 0.358, 95 CI = 0.137-0.932, = 0.04), pulmonary complications (aOR = 0.686, 95 CI = 0.494-0.952, = 0.02), bleeding requiring transfusion (aOR = 0.738, 95 CI = 0.601-0.906, < 0.01), wound complications (aOR = 0.626, 95 CI = 0.527-0.743, < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR = 0.781, 95 CI = 0.678-0.901, < 0.01), and 30-day readmission (aOR = 0.811, 95 CI = 0.676-0.972, = 0.02). Moreover, patients with OAP had shorter length of stay ( < 0.01).ConclusionThe use of OAP in elective UC colectomy was shown to have additional benefits beyond surgical site infections. Further large-scale randomized trials may be needed to determine the cause and effect of these observations.