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. 2022 Sep;407(6):2441-2452.
doi: 10.1007/s00423-022-02540-6. Epub 2022 May 13.

Selective decontamination of the digestive tract in colorectal surgery reduces anastomotic leakage and costs: a propensity score analysis

Andreas Bogner  1   2   3   4   5   6 , Maximilian Stracke  7   8   9   10 , Ulrich Bork  11   7   8   9   10 , Steffen Wolk  11   7   8   9   10 , Mathieu Pecqueux  11   7   8   9   10 , Sandra Kaden  7   8   9   10   12 , Marius Distler  11   7   8   9   10 , Christoph Kahlert  11   7   8   9   10 , Jürgen Weitz  11   7   8   9   10 , Thilo Welsch  7   8   9   10   13 , Johannes Fritzmann  11   7   8   9   10
Affiliations

Selective decontamination of the digestive tract in colorectal surgery reduces anastomotic leakage and costs: a propensity score analysis

Andreas Bogner et al. Langenbecks Arch Surg. 2022 Sep.

Abstract

Purpose: Anastomotic leakage (AL) and surgical site infection (SSI) account for most postoperative complications in colorectal surgery. The aim of this retrospective trial was to investigate whether perioperative selective decontamination of the digestive tract (SDD) reduces these complications and to provide a cost-effectiveness model for elective colorectal surgery.

Methods: All patients operated between November 2016 and March 2020 were included in our analysis. Patients in the primary cohort (PC) received SDD and those in the historical control cohort (CC) did not receive SDD. In the case of rectal/sigmoid resection, SDD was also applied via a transanally placed Foley catheter (TAFC) for 48 h postoperatively. A propensity score-matched analysis was performed to identify risk factors for AL and SSI. Costs were calculated based on German diagnosis-related group (DRG) fees per case.

Results: A total of 308 patients (154 per cohort) with a median age of 62.6 years (IQR 52.5-70.8) were analyzed. AL was observed in ten patients (6.5%) in the PC and 23 patients (14.9%) in the CC (OR 0.380, 95% CI 0.174-0.833; P = 0.016). SSI occurred in 14 patients (9.1%) in the PC and 30 patients in the CC (19.5%), representing a significant reduction in our SSI rate (P = 0.009). The cost-effectiveness analysis showed that SDD is highly effective in saving costs with a number needed to treat of 12 for AL and 10 for SSI.

Conclusion: SDD significantly reduces the incidence of AL and SSI and saves costs for the general healthcare system.

Keywords: Anastomotic leakage; Colorectal surgery; Cost reduction; Mechanical bowel preparation; Oral antibiotics; Surgical site infection.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure1
Figure1
Comparison of treatment costs. Median treatment costs in € between patients receiving SDD or not (A), patients with AL or not (B), and patients with SSI or not (C) are demonstrated. AL, anastomotic leakage; SDD, selective decontamination of the digestive tract; SSI, surgical site infection; n, number
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