Effect of preadmission bowel preparation on outcomes of elective colorectal procedures in young children

Guillermo J. Ares, Irene Helenowski, Catherine J. Hunter, Marybeth Madonna, Marleta Reynolds, Timothy Lautz*

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background: The utility of mechanical bowel preparation (MBP) to minimize infectious complications in elective colorectal surgery is contentious. Though data is scarce in children, adult studies suggest a benefit to MBP when administered with oral antibiotics (OAB). Methods: After IRB approval, the Pediatric Health Information System (PHIS) was queried for young children undergoing elective colon surgery from 2011 to 2014. Patients were divided into: no bowel preparation (Group 1), MBP (Group 2), and MBP plus OAB (Group 3). Statistical significance was determined using univariate and multivariate analysis with GEE models accounting for clustering by hospital. Results: One thousand five hundred eighty-one patients met study criteria: 63.7% in Group 1, 27.1% in Group 2, and 9.2% in Group 3. Surgical complication rate was higher in Group 1 (23.3%) compared to Groups 2 and 3 (14.2% and 15.5%; P < 0.001). However, median length of stay was shorter in Group 1 (4, IQR 4 days) compared to Group 2 (5, IQR 3) and Group 3 (6, IQR 3) (P < 0.001). 30-day readmission rates were similar. In multivariate analysis compared to patients in Group 1, the odds of surgical complications were 0.72 (95% CI 0.40–1.29, P = 0.28) with MBP alone (Group 2), 1.79 (95% CI 1.28–2.52, P = 0.0008) with MBP + OAB (Group 3), and 1.13 (95% CI 0.81–1.58, P = 0.46) for the aggregate Group 2 plus 3. Conclusion: Utilization of bowel preparation in children is variable across children's hospitals nationally, and the benefit is unclear. Given the discrepancy with adult literature, a three-armed pediatric-specific randomized controlled trial is warranted. Level of evidence: Level III treatment study – retrospective comparative study.

Original languageEnglish (US)
Pages (from-to)704-707
Number of pages4
JournalJournal of pediatric surgery
Volume53
Issue number4
DOIs
StatePublished - Apr 2018

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Keywords

  • Anastomotic leak
  • Bowel preparation
  • Colorectal surgery
  • Surgical complication
  • Surgical site infection

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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