Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery. Issue 12 (9th October 2013)

• Record Type: Journal Article
• Authors: Roos, D.; Dijksman, L. M.; Tijssen, J. G.; Gouma, D. J.; Gerhards, M. F.; Oudemans‐van Straaten, H. M.
• Is Part Of: British journal of surgery. Volume 100:Issue 12(2013:Dec.)
• Page Start: 1579
• Page End: 1588
• Publication Date: 2013-10-09
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.9254
• Languages: English
• ISSNs: 0007-1323

Abstract

<abstract abstract-type="main" id="bjs9254-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjs9254-sec-0001" sec-type="section"> <title>Background</title> <p id="bjs9254-para-0001"> <bold>Studies on selective decontamination of the digestive tract (SDD) in elective gastrointestinal surgery have shown decreased rates of postoperative infection and anastomotic leakage. However, the prophylactic use of perioperative SDD in elective gastrointestinal surgery is not generally accepted</bold>.</p> </sec> <sec id="bjs9254-sec-0002" sec-type="section"> <title>Methods</title> <p id="bjs9254-para-0002"> <bold>A systematic review of randomized clinical trials (RCTs) was conducted to compare the effect of perioperative SDD with systemic antibiotics (SDD group) with systemic antibiotic prophylaxis alone (control group), using MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. Endpoints included postoperative infection, anastomotic leakage, and in‐hospital or 30‐day mortality</bold>.</p> </sec> <sec id="bjs9254-sec-0003" sec-type="section"> <title>Results</title> <p id="bjs9254-para-0003"> <bold>Eight RCTs published between 1988 and 2011, with a total of 1668 patients (828 in the SDD group and 840 in the control group), were included in the meta‐analysis. The total number of patients with infection (reported in 5 trials) was 77 (19·2 per cent) of 401 in the SDD group, compared with 118 (28·2 per cent) of 418 in the control group (odds ratio 0·58, 95 per cent confidence interval 0·42 to 0·82; <italic>P</italic> = 0·002). The incidence of anastomotic leakage was significantly lower in the SDD group: 19 (3·3 per cent) of 582 patients <italic>versus</italic> 44 (7·4 per cent) of 595 patients in the control group (odds ratio 0·42, 0·24 to 0·73; <italic>P</italic> = 0·002)</bold>.</p> </sec> <sec id="bjs9254-sec-0004" sec-type="section"> <title>Conclusion</title> <p id="bjs9254-para-0004"> <bold>This systematic review and meta‐analysis suggests that a combination of perioperative SDD and perioperative intravenous antibiotics in elective gastrointestinal surgery reduces the rate of postoperative infection including anastomotic leakage compared with use of intravenous antibiotics alone</bold>.</p> </sec> </abstract>