Perioperative selective decontamination of the digestive tract (SDD) in elective colorectal surgery

Abstract

Background: Selective decontamination of the digestive tract (SDD) decreases morbidity and mortality in critically ill patients and morbidity in patients undergoing esophageal resection. This study analyzes the effect of perioperative SDD in patients undergoing elective colorectal surgery on postoperative infections and anastomotic leakage.

Methods: This is a retrospective analysis of prospectively collected data in a 3-year cohort of 162 patients undergoing elective resection of colon and or rectum. Of these patients, 76 (47%) received SDD (polymyxine B sulfate, tobramycin, and amphotericin) perioperatively. The control group consisted of 86 patients who were not treated with SDD. Postoperative complications, hospital stay, and mortality were analyzed.

Results: In the SDD group, there were six patients (7.9%) with infectious complications compared with 17 patients (19.8%) in the control group (p = 0.031). The incidence of the combined endpoint infectious complications and anastomotic leakage was 8 (11%) in the SDD group vs. 22 (26%) in the control group (p = 0.014). Multivariate analysis showed that no-SDD, aged above 60 years and diabetes were independent predictors of postoperative complications.

Conclusion: Perioperative SDD in elective colorectal surgery seems to reduce postoperative surgical complications including infectious complications and anastomotic leakage. Prospective, randomized, placebo-controlled studies are needed to confirm this conclusion.