Guillermo J Ares1, Irene Helenowski2, Catherine J Hunter3, Marybeth Madonna4, Marleta Reynolds4, Timothy Lautz5. 1. Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, 225 E Chicago Avenue, Box 63, Chicago, IL 60611; University of Illinois at Chicago, Department of Surgery, 840 South Wood Street, Suite 376-CSN, Chicago, IL 60612. 2. Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL 60611. 3. Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, 225 E Chicago Avenue, Box 63, Chicago, IL 60611; Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL 60611. 4. Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, 225 E Chicago Avenue, Box 63, Chicago, IL 60611. 5. Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, 225 E Chicago Avenue, Box 63, Chicago, IL 60611. Electronic address: tlautz@luriechildrens.org.
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 4days) 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.
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 4days) 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.