Association of bowel preparation with surgical-site infection in gynecologic oncology surgery: Post-hoc analysis of a randomized controlled trial

Objective. To determine the relationship between bowel preparation and surgical-site infection (SSI) inci-dence following colorectal resection during gynecologic oncology surgery.Methods. This post-hoc analysis used data from a randomized controlled trial of patients enrolled from 03/01/ 2016-08/20/2019 with presumed gynecologic malignancy investigating negative-pressure wound therapy among those requiring laparotomy. Patients were treated preoperatively without bowel preparation, oral antibi-otic bowel preparation (OABP), or OABP plus mechanical bowel preparation (MBP) per surgeon preference. Uni-variate and multivariable analyses with stepwise model selection for SSI were performed for confirmed gynecologic malignancies requiring colorectal resection.Results. Of 161 cases, 15 (9%) had no preparation, 39 (24%) OABP only, and 107 (66%) OABP+MBP. The overall SSI rate was 19% (n = 31)-53% (n = 8/15) in the no preparation, 21% (n = 8/39) in the OABP alone, and 14% (n = 15/107) in the OABP+MBP groups (P = 0.003). The difference between OABP and OABP+MBP was non-significant (P = 0.44). The median length of stay was 9 (range, 6-12), 6 (range, 5-8), and 7 days (range, 6-10), respectively (P = 0.045). The overall complication rate (34%; n = 54) did not significantly vary by preparation type (P = 0.23). On univariate logistic regression analysis, OABP (OR, 0.23; 95% CI: 0.06-0.80) and OABP+MBP (OR, 0.14; 95% CI: 0.04-0.45) were associated with decreased SSI risk compared to no preparation (P = 0.004). On multivariate analysis, both methods of preparation retained a significant impact on SSI rates (P = 0.004). Conclusion. Bowel preparation is associated with reduced SSI incidence and is beneficial for patients undergo-ing gynecologic oncology surgery with anticipated colorectal resection. Further investigation is needed to deter-mine whether OABP alone is sufficient.(c) 2022 Elsevier Inc. All rights reserved.