Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 30;12(15):1513.
doi: 10.3390/healthcare12151513.

Racial Disparities in Bowel Preparation and Post-Operative Outcomes in Colorectal Cancer Patients

Alexandra E Hernandez  1   2 , Matthew Meece  1   2 , Kelley Benck  3 , Gianna Bello  3 , Carlos Theodore Huerta  1   2 , Brianna L Collie  1   2 , Jennifer Nguyen  4 , Nivedh Paluvoi  1   2   5
Affiliations

Racial Disparities in Bowel Preparation and Post-Operative Outcomes in Colorectal Cancer Patients

Alexandra E Hernandez et al. Healthcare (Basel). .

Abstract

Background: Combined pre-operative bowel preparation with oral antibiotics (OAB) and mechanical bowel preparation (MBP) is the current recommendation for elective colorectal surgery. Few have studied racial disparities in bowel preparation and subsequent post-operative complications.

Methods: This retrospective cohort study used 2015-2021 ACS-NSQIP-targeted data for elective colectomy for colon cancer. Multivariate regression evaluated predictors of post-operative outcomes: post-operative ileus, anastomotic leak, surgical site infection (SSI), operative time, and hospital length of stay (LOS).

Results: 72,886 patients were evaluated with 82.1% White, 11.1% Black, and 6.8% Asian or Asian Pacific Islander (AAPI); 4.2% were Hispanic and 51.4% male. Regression accounting for age, sex, ASA classification, comorbidities, and operative approach showed Black, AAPI, and Hispanic patients were more likely to have had no bowel preparation compared to White patients receiving MBP+OAB. Compared to White patients, Black and AAPI patients had higher odds of prolonged LOS and pro-longed operative time. Black patients had higher odds of post-operative ileus.

Conclusions: Racial disparities exist in both bowel preparation administration and post-operative complications despite the method of bowel preparation. This warrants exploration into discriminatory bowel preparation practices and potential differences in the efficacy of bowel preparation in specific populations due to biological or social differences, which may affect outcomes. Our study is limited by its use of a large database that lacks socioeconomic variables and patient data beyond 30 days.

Keywords: colorectal surgery; health disparities; post-operative outcomes.

PubMed Disclaimer

Conflict of interest statement

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study Flow Diagram.
Figure 2
Figure 2
Odds ratios for post-operative complications by race and ethnicity groups compared to non-Hispanic White patients. Odds ratios are adjusted for age, sex, ASA classification, BMI, diabetes, congestive heart failure, ascites, dialysis dependence, bowel preparation received, and planned operative approach. * p < 0.05; ** p < 0.01.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Altemeier W.A., Culbertson W.R., Veto M. Prophylactic antibiotic therapy. AMA Arch. Surg. 1955;71:2–6. doi: 10.1001/archsurg.1955.01270130004002. - DOI - PubMed
    1. Nichols R.L., Condon R.E., Gorbach S.L., Nyhus L.M. Efficacy of preoperative antimicrobial preparation of the bowel. Ann. Surg. 1972;176:227–232. doi: 10.1097/00000658-197208000-00019. - DOI - PMC - PubMed
    1. Bucher P., Gervaz P., Soravia C., Mermillod B., Erne M., Morel P. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br. J. Surg. 2005;92:409–414. doi: 10.1002/bjs.4900. - DOI - PubMed
    1. Ram E., Sherman Y., Weil R., Vishne T., Kravarusic D., Dreznik Z. Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study. Arch. Surg. 2005;140:285–288. doi: 10.1001/archsurg.140.3.285. - DOI - PubMed
    1. Jung B., Pahlman L., Nystrom P.O., Nilsson E., Mechanical Bowel Preparation Study G. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br. J. Surg. 2007;94:689–695. doi: 10.1002/bjs.5816. - DOI - PubMed

LinkOut - more resources