Oral Antibiotics Alone versus Oral Antibiotics Combined with Mechanical Bowel Preparation for Elective Colorectal Surgery: A Propensity Score-Matching Re-Analysis of the iCral 2 and 3 Prospective Cohorts
Marco Catarci,
Stefano Guadagni,
Francesco Masedu,
Massimo Sartelli,
Leonardo Antonio Montemurro,
Gian Luca Baiocchi,
Giovanni Domenico Tebala,
Felice Borghi,
Pierluigi Marini,
Marco Scatizzi,
the Italian ColoRectal Anastomotic Leakage (iCral) Study Group
Affiliations
Marco Catarci
General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, 00157 Roma, Italy
Stefano Guadagni
General Surgery Unit, University of L’Aquila, 67100 L’Aquila, Italy
Francesco Masedu
Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
Massimo Sartelli
General Surgery Unit, Santa Lucia Hospital, 62100 Macerata, Italy
Leonardo Antonio Montemurro
General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, 00157 Roma, Italy
Gian Luca Baiocchi
General Surgical Unit, Department of Clinical and Experimental Sciences, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST), 26100 Cremona, Italy
Giovanni Domenico Tebala
Digestive & Emergency Surgery Unit, Santa Maria Hospital, 05100 Terni, Italy
Felice Borghi
Oncologic Surgery Unit, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
Pierluigi Marini
General & Emergency Surgery Unit, San Camillo-Forlanini Hospital, 00152 Roma, Italy
Marco Scatizzi
General Surgery Unit, Santa Maria Annunziata & Serristori Hospital, 50012 Firenze, Italy
the Italian ColoRectal Anastomotic Leakage (iCral) Study Group
The evidence regarding the role of oral antibiotics alone (oA) or combined with mechanical bowel preparation (MoABP) for elective colorectal surgery remains controversial. A prospective database of 8359 colorectal resections gathered over a 32-month period from 78 Italian surgical units (the iCral 2 and 3 studies), reporting patient-, disease-, and procedure-related variables together with 60-day adverse events, was re-analyzed to identify a subgroup of 1013 cases (12.1%) that received either oA or MoABP. This dataset was analyzed using a 1:1 propensity score-matching model including 20 covariates. Two well-balanced groups of 243 patients each were obtained: group A (oA) and group B (MoABP). The primary endpoints were anastomotic leakage (AL) and surgical site infection (SSI) rates. Group A vs. group B showed a significantly higher AL risk [14 (5.8%) vs. 6 (2.5%) events; OR: 3.77; 95%CI: 1.22–11.67; p = 0.021], while no significant difference was recorded between the two groups regarding SSIs. These results strongly support the use of MoABP for elective colorectal resections.
