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

2024; Springer Science+Business Media; Volume: 39; Issue: 1 Linguagem: Inglês

10.1007/s00384-024-04627-6

1432-1262

Marco Catarci, Stefano Guadagni, Francesco Masedu, Giacomo Ruffo, Massimo Viola, Felice Borghi, Gianluca Garulli, Felice Pirozzi, Paolo Delrio, Raffaele De Luca, Giànandrea Baldazzi, Marco Scatizzi, Paolo Ciano, Michele Benedetti, L Montemurro, Marco Clementi, Elisa Bertocchi, Gaia Masini, Amedeo Altamura, Francesco Rubichi, Marcello Migliore, D Parlanti, Gabriele Vago, Antonio Sciuto, Ugo Pace, Andrea Fares Bucci, Michele De Simone, Diletta Cassini, Lorenzo Pandolfini, Alessandro Falsetto, Ferdinando Ficari, Francesco Giudici, Fabio Cianchi, Alberto Patriti, Marcella Lodovica Ricci, Walter Siquini, A. Cardinali, Stefano D’Ugo, Marcello Spampinato, Stefano Scabini, Alessandra Aprile, Domenico Soriero, Marco Caricato, Gabriella Teresa Capolupo, Giusto Pignata, Jacopo Andreuccetti, Ilaria Canfora, Andrea Liverani, Giuseppe Lamacchia, Claudia Franceschilli, Roberto Campagnacci, Angela Maurizi, Pierluigi Marini, Grazia Maria Attinà, Ugo Elmore, Francesco Puccetti, Francesco Corcione, Umberto Bracale, Roberto Peltrini, Roberto Santoro, Pietro Maria Amodio, Massimo Carlini, Domenico Spoletini, Rosa Marcellinaro, Antonio Giuliani, Giovanni Del Vecchio, Mario Sorrentino, Massimo Stefanoni, Giovanni Ferrari, Pietro Maria Lombardi, Alberto Di Leo, Lorenzo Crepaz, Augusto Verzelli, Andrea Budassi, Giuseppe Sica, Giulia Bagaglini, Stefano Rausei, Silvia Tenconi, Davide Cavaliere, Leonardo Solaini, Giorgio Ercolani, Gian Luca Baiocchi, Sarah Molfino, Marco Milone, Giovanni Domenico De Palma, Giovanni Ciaccio, Paolo Locurto, Giovanni Domenico Tebala, Antonio Di Cintio, Luigi Boni, Elisa Cassinotti, Stefano Mancini, Andrea Sagnotta, Mario Guerrieri, Monica Ortenzi, Roberto Persiani, Alberto Biondi, Andrea Lucchi, Giulia Vitali, Dario Parini, Maurizio De Luca, Antonino Spinelli, Francesco Maria Carrano, Michele Genna, Francesca Fior, Vincenzo Bottino, Antonio Ferronetti, Andrea Coratti, Giuseppe Giuliani, Roberto Benigni, Dario Scala, Battistino Puppio, Alessio Vagliasindi, Andrea Muratore, Patrizia Marsanic, Nicoletta Sveva Pipitone Federico, Maurizio Pavanello, Carlo Di Marco, Umberto Rivolta, Camillo Leonardo Bertoglio, Micaela Piccoli, Francesca Pecchini, Carlo Talarico, Vincenzo Greco, A. Carrara, Michele Motter, Giuseppe Tirone, Mauro Totis, Nicolò Tamini, Franco Roviello, Riccardo Piagnerelli, Alessandro Anastasi, Giuseppe Canonico, Gianluca Guercioni, Simone Cicconi, Giuseppe Maria Ettorre, Marco Colasanti, Mauro Montuori, Enrico Pinotti, Pierpaolo Mariani, Roberta Carminati, Nicolò de Manzini, Edoardo Osenda, Annibale Donini, Luigina Graziosi, Mariano Fortunato Armellino, Ciro De Martino, Lucio Taglietti, Arianna Birindelli, Gabriele Anania, Matteo Chiozza, Mariantonietta Di Cosmo, Daniele Zigiotto, Carlo V. Feo, Fioralba Pindozzi, Paolo Millo, Manuela Grivon, Corrado Pedrazzani, Cristian Conti, Silvio Guerriero, Lorenzo Organetti, Andrea Costanzi, Michela Monteleone, Nereo Vettoretto, Emanuele Botteri, Federico Marchesi, Giorgio Dalmonte, Massimo Basti, Diletta Frazzini, Graziano Longo, Simone Santoni, Moreno Cicetti, Gabriele La Gioia, Giuseppe Brisinda, Stefano Berti,

Gastric Cancer Management and Outcomes

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.