Preoperative bowel preparation versus no preparation before spinal surgery: A randomised clinical trial

Abstract

Aims and objectives: To investigate the effect of preoperative bowel preparation for patients undergoing spinal fusion surgery.

Background: Bowel preparation before major surgery is performed routinely to reduce the risk of postoperative complications related to gastrointestinal function.

Methods: A randomised clinical trial was performed that included forty-five elective spinal fusion patients allocated to one control group and two treatment groups. The patients received preoperative bowel preparation with enema, suppository or no bowel preparation. The outcome measures were defecation within 72 hours postoperatively, defecation on the fifth postoperative day, postoperative constipation, nausea, pain, well-being and ambulation.

Results: There were significant differences in favour of no bowel preparation compared with suppository group for the primary outcome; days to first defecation. There was a tendency for the patients who received no bowel preparation to recover from constipation more quickly than patients in the bowel preparation groups. The majority of patients did not defecate until the fourth postoperative day.

Conclusions: This randomised study found no benefit from bowel preparation before major spine surgery on gastrointestinal function. The use of bowel preparation is not evidence-based and not performing it should be considered before major spine surgery until the effect is known.

Keywords: Bowel preparation; Constipation; Enema; Ileus; Postoperative care; Postoperative complication; Spinal fusion.