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International Journal of Colorectal Disease

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Open Access 01-12-2024 | Antibiotic | RESEARCH

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

Authors: Marco Catarci, Stefano Guadagni, Francesco Masedu, Giacomo Ruffo, Massimo Giuseppe Viola, Felice Borghi, Gianluca Garulli, Felice Pirozzi, Paolo Delrio, Raffaele De Luca, Gianandrea Baldazzi, Marco Scatizzi, The Italian ColoRectal Anastomotic Leakage (iCral) study group

Published in: International Journal of Colorectal Disease | Issue 1/2024

Abstract

Background

Current evidence concerning bowel preparation before elective colorectal surgery is still controversial. This study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation.

Methods

A prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). Twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. The primary endpoints were AL, SSIs, and OM. All the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI).

Results

Compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23–2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10–1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25–0.79; p = .008).

Conclusions

MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP.

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Title: Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort
Authors: Marco Catarci
Stefano Guadagni
Francesco Masedu
Giacomo Ruffo
Massimo Giuseppe Viola
Felice Borghi
Gianluca Garulli
Felice Pirozzi
Paolo Delrio
Raffaele De Luca
Gianandrea Baldazzi
Marco Scatizzi
The Italian ColoRectal Anastomotic Leakage (iCral) study group
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Antibiotic
Metronidazole
Published in: International Journal of Colorectal Disease / Issue 1/2024
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-024-04627-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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