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Abstract：
To determine the relationship between bowel preparation and surgical-site infection (SSI) incidence following colorectal resection during gynecologic oncology surgery.
This post-hoc analysis used data from a randomized controlled trial of patients enrolled from 03/01/2016-08/20/2019 with presumed gynecologic malignancy investigating negative-pressure wound therapy among those requiring laparotomy. Patients were treated preoperatively without bowel preparation, oral antibiotic bowel preparation (OABP), or OABP plus mechanical bowel preparation (MBP) per surgeon preference. Univariate and multivariable analyses with stepwise model selection for SSI were performed for confirmed gynecologic malignancies requiring colorectal resection.
Of 161 cases, 15 (9%) had no preparation, 39 (24%) OABP only, and 107 (66%) OABP+MBP. The overall SSI rate was 19% (n = 31)-53% (n = 8/15) in the no preparation, 21% (n = 8/39) in the OABP alone, and 14% (n = 15/107) in the OABP+MBP groups (P = 0.003). The difference between OABP and OABP+MBP was non-significant (P = 0.44). The median length of stay was 9 (range, 6-12), 6 (range, 5-8), and 7 days (range, 6-10), respectively (P = 0.045). The overall complication rate (34%; n = 54) did not significantly vary by preparation type (P = 0.23). On univariate logistic regression analysis, OABP (OR, 0.23; 95% CI: 0.06-0.80) and OABP+MBP (OR, 0.14; 95% CI: 0.04-0.45) were associated with decreased SSI risk compared to no preparation (P = 0.004). On multivariate analysis, both methods of preparation retained a significant impact on SSI rates (P = 0.004).
Bowel preparation is associated with reduced SSI incidence and is beneficial for patients undergoing gynecologic oncology surgery with anticipated colorectal resection. Further investigation is needed to determine whether OABP alone is sufficient.
This post-hoc analysis used data from a randomized controlled trial of patients enrolled from 03/01/2016-08/20/2019 with presumed gynecologic malignancy investigating negative-pressure wound therapy among those requiring laparotomy. Patients were treated preoperatively without bowel preparation, oral antibiotic bowel preparation (OABP), or OABP plus mechanical bowel preparation (MBP) per surgeon preference. Univariate and multivariable analyses with stepwise model selection for SSI were performed for confirmed gynecologic malignancies requiring colorectal resection.
Of 161 cases, 15 (9%) had no preparation, 39 (24%) OABP only, and 107 (66%) OABP+MBP. The overall SSI rate was 19% (n = 31)-53% (n = 8/15) in the no preparation, 21% (n = 8/39) in the OABP alone, and 14% (n = 15/107) in the OABP+MBP groups (P = 0.003). The difference between OABP and OABP+MBP was non-significant (P = 0.44). The median length of stay was 9 (range, 6-12), 6 (range, 5-8), and 7 days (range, 6-10), respectively (P = 0.045). The overall complication rate (34%; n = 54) did not significantly vary by preparation type (P = 0.23). On univariate logistic regression analysis, OABP (OR, 0.23; 95% CI: 0.06-0.80) and OABP+MBP (OR, 0.14; 95% CI: 0.04-0.45) were associated with decreased SSI risk compared to no preparation (P = 0.004). On multivariate analysis, both methods of preparation retained a significant impact on SSI rates (P = 0.004).
Bowel preparation is associated with reduced SSI incidence and is beneficial for patients undergoing gynecologic oncology surgery with anticipated colorectal resection. Further investigation is needed to determine whether OABP alone is sufficient.
摘要：
目的：确定妇科肿瘤外科手术中结直肠切除术后肠道准备与手术部位感染（SSI）发生率之间的关系。
方法：本事后分析使用了一项随机对照试验的数据，该试验的数据来自于2016年03月01日至2019年08月20日招募的假定妇科恶性肿瘤患者，调查需要剖腹手术的患者中的负压伤口治疗。患者术前接受治疗，没有肠道准备，口服抗生素肠道准备（OABP），或OABP加机械肠道准备（MBP）根据外科医生的喜好。对确诊需要结直肠切除的妇科恶性肿瘤进行单变量和多变量分析，并逐步选择SSI模型。
结果：161例，15(9%)没有准备，39（24%）OABP，107（66%）OABP+MBP。在无制剂中，整体SSI率为19%(n=31)-53%(n=8/15)，21%(n=8/39)在单独的OABP中，OABP+MBP组(P=0.003)为14%(n=15/107)。OABP与OABP+MBP差异无统计学意义(P=0.44)。中位住院时间为9(范围，6-12),6(范围,5-8),和7天(范围，6-10),分别为(P=0.045)。总体并发症发生率（34％；n=54）没有显着差异（P=0.23）。在单因素Logistic回归分析中，OABP(或,0.23；95%CI：0.06-0.80)和OABP+MBP(OR，0.14；95%CI：0.04-0.45）与未准备的SSI风险降低相关（P=0.004）。在多变量分析中，两种制备方法均保留了对SSI发生率的显著影响(P=0.004).
结论：肠道准备与降低SSI发生率相关，并且对于接受妇科肿瘤手术并进行预期结直肠切除术的患者是有益的。需要进一步调查以确定单独的OABP是否足够。
方法：本事后分析使用了一项随机对照试验的数据，该试验的数据来自于2016年03月01日至2019年08月20日招募的假定妇科恶性肿瘤患者，调查需要剖腹手术的患者中的负压伤口治疗。患者术前接受治疗，没有肠道准备，口服抗生素肠道准备（OABP），或OABP加机械肠道准备（MBP）根据外科医生的喜好。对确诊需要结直肠切除的妇科恶性肿瘤进行单变量和多变量分析，并逐步选择SSI模型。
结果：161例，15(9%)没有准备，39（24%）OABP，107（66%）OABP+MBP。在无制剂中，整体SSI率为19%(n=31)-53%(n=8/15)，21%(n=8/39)在单独的OABP中，OABP+MBP组(P=0.003)为14%(n=15/107)。OABP与OABP+MBP差异无统计学意义(P=0.44)。中位住院时间为9(范围，6-12),6(范围,5-8),和7天(范围，6-10),分别为(P=0.045)。总体并发症发生率（34％；n=54）没有显着差异（P=0.23）。在单因素Logistic回归分析中，OABP(或,0.23；95%CI：0.06-0.80)和OABP+MBP(OR，0.14；95%CI：0.04-0.45）与未准备的SSI风险降低相关（P=0.004）。在多变量分析中，两种制备方法均保留了对SSI发生率的显著影响(P=0.004).
结论：肠道准备与降低SSI发生率相关，并且对于接受妇科肿瘤手术并进行预期结直肠切除术的患者是有益的。需要进一步调查以确定单独的OABP是否足够。
