Use of mechanical bowel preparation and oral antibiotics for elective colorectal procedures in children: Is current practice evidence-based?

Elliot C. Pennington, Christina Feng, Shawn D. St. Peter, Saleem Islam, Adam B. Goldin, Fizan Abdullah, Shawn J. Rangel*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Purpose It is well established through randomized trials that oral antibiotics given with or without a mechanical bowel preparation (MBP) prior to colorectal procedures reduce complications, while MBP given alone provides no benefit. We aimed to characterize trends surrounding bowel preparation in children and determine whether contemporary practice is evidence-based. Methods Retrospective analysis of patients undergoing colorectal procedures at 42 children's hospitals (1/2/2007-12/31/2011) was performed. Patients were analyzed for diagnosis, pre-admission status, and inpatient bowel preparation. Bowel preparation was considered evidence-based if oral antibiotics were utilized with or without a MBP. Results 49% of all patients were pre-admitted (n = 5,473), and the most common diagnoses were anorectal malformations (55%), inflammatory bowel disease (26%), and Hirschsprung's Disease (19%). The most common preparation approaches were MBP alone (54.3%), MBP + oral antibiotics (18.8%), and oral antibiotics alone (4.2%), although significant variation was found in hospital-specific rates for each approach (MBP alone: 0-96.1%, MBP + oral antibiotics: 0-83.6%, orals alone: 0-91.6%, p < 0.0001). Only 22.9% of all patients received an evidence-based preparation (range by hospital: 0-92.3%, p < 0.0001), and this rate decreased significantly during the five-year study period (27.6% in 2007 vs. 17.3% in 2011, p < 0.0001). Conclusion According to the best available clinical evidence, less than a quarter of all children pre-admitted for elective colorectal procedures receive a bowel preparation proven to reduce infectious complications.

Original languageEnglish (US)
Pages (from-to)1030-1035
Number of pages6
JournalJournal of pediatric surgery
Volume49
Issue number6
DOIs
StatePublished - Jun 2014

Keywords

  • Antibiotic prophylaxis
  • Mechanical bowel preparation
  • Non-absorbable oral antibioticsl colorectal surgery

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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