G.LEI1, L.TAN1, J.L.CHONG1, S.K.MANTOO1, P.TAN1, H.L.SIM1, J.F.FENG2, K.Y.TAN1, E.WONG1, D.LEE1
Khoo Teck Puat Hospital1, Woodlands Health2
Surgical site infection(SSI) in Colorectal surgery is prevalent compared to other elective abdominal surgery due to colonic bacterial load. This has serious implication on recovery, length of stay, readmission, need for further interventions and delay in oncological treatment. This study evaluated the effectiveness of mechanical with oral antibiotics preparation protocol(MOAPP) in affecting outcomes post-colorectal resection.
A retrospective review of all patients who underwent elective Colorectal resection from January 2019 to June 2021 was performed. Inclusion criteria are (1)elective open surgeries, (2)anterior resection with defunctioning ileostomy or (3)locally-advanced tumor requiring laparoscopically-assisted approach. Patient demographics, tumor location, surgical approach and outcomes were recorded. Primary outcomes include anastomotic leak and SSI; secondary outcomes include length of stay, readmission and 30-day mortality. Multivariate regression model was used to evaluate independent predictors of SSI.
A total of 148 patients were analysed (68 under MOAPP, 80 under non-MOAPP). MOAPP group had a lower SSI rate of 8.8% compared to 25% in non-MOAPP (p=0.018). Anastomotic complications were detected in 2 (2.9%) MOAPP patients and 5 (6.3%) non-MOAPP patients but the difference was not statistically significant (p=0.45). Multivariate analysis of factors affecting SSI revealed that MOAPP is an independent protective factor for SSI (OR=0.30, 95%CI 0.106-0.851; p=0.024) while open operation is an independent predictor for SSIs (OR=7.435, CI 1.863-29.666; p=0.004). There were no significant differences in anastomotic complications and secondary outcomes.
MOAPP is effective in reducing SSI (wound and intraabdominal infections). This is the first study conducted in Asian population and further larger scale studies should be done.