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Meta-analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical
bowel preparation alone to reduce surgical‐site infections in elective colorectal surgery
MEYER, Jérémy, et al .
Abstract
Comment on: Meta‐analysis of oral antibiotics, Meta-analysis of Oral Antibiotics, in Combination With Preoperative Intravenous Antibiotics and Mechanical Bowel Preparation the Day Before Surgery, Compared With Intravenous Antibiotics and Mechanical Bowel Preparation Alone to Reduce Surgical-Site Infections in Elective Colorectal Surgery ( BJS Open 2018; 2: 185-194)
MEYER, Jérémy, et al . Meta-analysis of oral antibiotics, in combination with preoperative
intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgical‐site infections in elective colorectal surgery. BJS Open , 2019, vol. 3, no. 6, p. 882-883
PMID : 31832596
DOI : 10.1002/bjs5.50198
Available at:
http://archive-ouverte.unige.ch/unige:128299
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Meta-analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and
mechanical bowel preparation alone to reduce surgical-site infections in elective colorectal surgery
(BJS Open2018; 2: 185–194) DOI:10.1002/bjs5.50198
We read with great interest the sys- tematic review and meta-analysis by McSorley et al.1 regarding the current controversy regarding the usefulness of mechanical bowel preparation before elective colorectal surgery. By pooling 22 studies totalling 57 207 patients, the authors demonstrated that preoperative oral antibiotics, in combination with intravenous antibiotics and mechanical bowel preparation, were associated with signicantly lower rates of surgical-site infection than intravenous antibiotics plus mechanical bowel preparation.
In their quantitative analysis, the authors pooled 14 RCTs involving 3014 patients, but also eight cohort studies with a total of 54 193 patients. Among the latter, the authors included the fol- lowing studies: the study of Morris and colleagues2, comprising 8415 patients from the National Surgical Quality Improvement Program (NSQIP) colec- tomy cohort from 2011 to 2012; the study of Moghadamyeghaneh and co- workers3, comprising 5021 patients from NSQIP from 2012 to 2013; the study of Kiran et al.4, comprising 8442 patients from NSQIP from 2012; the study of Koller and colleagues5, com- prising 32 359 patients from NSQIP from 2012 to 2014; and the study of Scarborough and co-workers6, compris- ing 4999 patients from NSQIP from 2012.
In addition, McSorley et al. included the study of Hendren and colleagues7,
which included 4331 patients from the Michigan Surgical Quality Collabora- tive (MSQC). However, we note that the list of participating hospitals in NSQIP in Michigan (https://www.facs.
org/search/nsqip-participants?state=MI) includes hospitals listed by the MSQC (https://msqc.org/about/member- hospitals/). Therefore, it is likely that patients reported by the MSQC are the same as those reported in the NSQIP. Only the studies of Konishi and co-workers8 (556 patients) and Cannon et al.9 (9940 patients from the Veterans Affairs Surgical Quality Improvement Program) might not have been duplicates.
Therefore, we raise the concern that McSorley and colleagues pooled dupli- cate patients in their quantitative ana- lysis, at least for the period after 2012, resulting in an increase in the weight of the NSQIP cohort for the investigated outcomes. Duplicate data should be avoided in meta-analyses10,11. However, it appears that the overall conclusions drawn by McSorley et al. were not affected by this methodological pitfall, as the findings of the subgroup analyses including only RCTs showed similar trends.
In conclusion, the effect of antibi- otics and mechanical bowel preparation on surgical-site infection during elective colorectal surgery cannot be assessed properly by analysis of the pooled data originating from the included cohort studies.
J. Meyer1,2 , E. Roos3, N. C. Buchs1,2 and F. Ris1,2
1Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, and2Unit of Surgical Research, Division of Digestive Surgery, Medical School, University of Geneva, Geneva, Switzerland, and3Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden jeremy.meyer@hcuge.ch 1 McSorley ST, Steele CW, McMahon AJ. Meta-analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and
mechanical bowel preparation the day
before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgical-site infections in elective colorectal surgery.BJS Open 2018;2: 185–194.
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© 2019 The Authors.BJS Openpublished by John Wiley & Sons Ltd on behalf of BJS Society Ltd BJS Open2019;3: 882–884 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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9 Cannon JA, Altom LK, Deierhoi RJ, Morris M, Richman JS, Vick CCet al.
Preoperative oral antibiotics reduce surgical site infection following elective colorectal resections.Dis Colon Rectum2012;55:
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