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. 2024 Apr 16;39(1):53.
doi: 10.1007/s00384-024-04627-6.

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

Marco Catarci  1 , Stefano Guadagni  2   3 , Francesco Masedu  4 , Giacomo Ruffo  5 , Massimo Giuseppe Viola  6 , Felice Borghi  7 , Gianluca Garulli  8 , Felice Pirozzi  9 , Paolo Delrio  10 , Raffaele De Luca  11 , Gianandrea Baldazzi  12 , Marco Scatizzi  13 ; Italian ColoRectal Anastomotic Leakage (iCral) study group
Collaborators, Affiliations

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

Marco Catarci et al. Int J Colorectal Dis. .

Abstract

Background: Current evidence concerning bowel preparation before elective colorectal surgery is still controversial. This study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation.

Methods: A prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). Twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. The primary endpoints were AL, SSIs, and OM. All the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI).

Results: Compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008).

Conclusions: MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP.

Keywords: Anastomotic leakage; Colorectal surgery; Mechanical bowel preparation; Oral antibiotics; Surgical site infections.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart. PEG, polyethylene glycol; MNA-SF, mini nutritional assessment–short form [38]; ERAS, enhanced recovery after surgery; NBP, no bowel preparation; oA, oral antibiotics; MBP, mechanical bowel preparation; MoABP, mechanical bowel preparation and oral antibiotics
Fig. 2
Fig. 2
Love plot of covariates’ Kolmogorov–Smirnov mean differences before and after adjustment using a machine learning technique, comparing the reference treatment (no bowel preparation, named “0” in the figure) with the other 3 treatments (oral antibiotics alone, named “1”; mechanical bowel preparation alone, named “2”; mechanical bowel preparation and oral antibiotics, named “3”); ERAS, enhanced recovery after surgery
Fig. 3
Fig. 3
Multi-treatment weighted logistic regression analysis for primary endpoints (log scale); NBP, no bowel preparation; oA, oral antibiotics alone; MBP, mechanical bowel preparation alone; MoABP, mechanical bowel preparation and oral antibiotics
See this image and copyright information in PMC

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