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Mechanical and oral antibiotic bowel preparation in ovarian cancer debulking: Are we lowering or just trading surgical complications?

  • Connor C. Wang
    Correspondence
    Corresponding author at: University of Wisconsin School of Medicine and Public Health, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, 600 Highland Avenue, H4/664, Madison, WI 53792, United States.
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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  • Rana Al-Rubaye
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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  • Vienna Tran
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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  • Lauren Montemorano
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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  • Ahmed Al-Niaimi
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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      Highlights

      • MOABP prior to bowel resection at ovarian cancer CRS was associated with lower deep/organspace SSI and readmissions.
      • MOABP prior to bowel resection was associated with higher odds of ICU admissions and grade ≥ 3 cardiac and GI complications.
      • MOABP prior to bowel resection may be associated with shorter hospital stays and more optimal resections.

      Abstract

      Objectives

      To examine postoperative complications associated with preoperative mechanical and oral antibiotic bowel preparation (MOABP) for patients with ovarian cancer who underwent bowel resection at cytoreductive surgery (CRS).

      Methods

      This was a single-institution retrospective study of patients with ovarian cancer undergoing CRS from 01/2011–12/2020 using ICD-10 diagnoses and procedure codes. Patients were stratified by those who underwent bowel resection versus no resection. Bowel resection patients were further stratified by those who underwent MOABP versus no bowel preparation. Patient demographics, tumor data, and perioperative metrics were collected. Unadjusted and adjusted logistic regression evaluated odds of 30-day postoperative complications in patients with bowel resection versus no resection and those with MOABP versus no bowel preparation.

      Results

      Of 919 patients identified, 215 (23.3%) required bowel resection, which included 81 (37.7%) who received MOABP. Patient characteristics, co-morbidities, and cancer data were similar between MOABP versus no bowel preparation patients. MOABP patients underwent more interval CRS (34.6% versus 9.0%), more optimal surgical resections (96.3% versus 83.8%), fewer diverting ostomies (13.5% versus 33.5%), and shorter hospital stays (7.1 versus 9.4 days) than no bowel preparation patients. On adjusted analyses, MOABP patients experienced significantly lower odds of deep/organ-space surgical infections and 30-day readmissions but higher odds of unplanned intensive care unit (ICU) admissions and grade 3 or higher cardiac and gastrointestinal complications.

      Conclusions

      Patients who underwent preoperative MOABP prior to ovarian cancer CRS with bowel resection had lower odds or deep/organ-space infections and readmissions, shorter hospital stays, fewer diverting ostomies, and more optimal resections. However, these patients also experienced higher odds of ICU admissions and grade 3 or higher cardiac and gastrointestinal complications. The positive and negative postoperative outcomes in this population should be considered in clinical practice.

      Keywords

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