Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort,International Journal of Colorectal Disease

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Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort
International Journal of Colorectal Disease ( IF 2.8 ) Pub Date : 2024-04-16 , DOI: 10.1007/s00384-024-04627-6
Marco Catarci , Stefano Guadagni , Francesco Masedu , Giacomo Ruffo , Massimo Giuseppe Viola , Felice Borghi , Gianluca Garulli , Felice Pirozzi , Paolo Delrio , Raffaele De Luca , Gianandrea Baldazzi , Marco Scatizzi , Paolo Ciano , Michele Benedetti , Leonardo Antonio Montemurro , Marco Clementi , Elisa Bertocchi , Gaia Masini , Amedeo Altamura , Francesco Rubichi , Marco Migliore , Daniele Parlanti , Gabriele Vago , Antonio Sciuto , Ugo Pace , Andrea Fares Bucci , Michele Simone , Diletta Cassini , Lorenzo Pandolfini , Alessandro Falsetto , Ferdinando Ficari , Francesco Giudici , Fabio Cianchi , Alberto Patriti , Marcella Lodovica Ricci , Walter Siquini , Alessandro 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 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 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 , Alessandro 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 Vittorio 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 ,

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.

中文翻译：

择期结直肠切除术的肠道准备：对来自意大利前瞻性队列的 6241 例病例进行多治疗机器学习分析

背景

目前关于择期结直肠手术前肠道准备的证据仍然存在争议。本研究旨在比较使用四种不同类型的肠道准备的择期结直肠手术后吻合口瘘 (AL)、手术部位感染 (SSI) 的发生率和总体发病率（任何不良事件，OM）。

方法

在两项前瞻性研究中收集了 78 个意大利外科中心的前瞻性数据库，其中包括 6241 名因恶性或良性疾病接受选择性结直肠切除和吻合术的患者，通过考虑无肠道准备的多治疗机器学习模型 (NBP;与单独口服抗生素（oA；人数 = 406；6.5%）、单独机械性肠道准备（MBP；人数 = 1486；23.8%）或联合治疗相比，作为参考治疗组与 oAB (MoABP；数量 = 607；9.7%)。与生物特征数据、外科手术、围手术期管理以及可能影响结果的医院/中心数据相关的 20 个协变量被纳入模型并在模型中进行平衡。主要终点是 AL、SSI 和 OM。所有结果均以比值比 (OR) 报告，置信区间为 95% (95% CI)。

结果

与 NBP 相比，MBP 的 AL 风险（OR 1.82；95% CI 1.23–2.71；p = .003）和 OM 风险（OR 1.38；95% CI 1.10–1.72；p = .005）显着较高，但无显着差异。 oA 组记录了所有终点，而 MoABP 显示 SSI 风险显着降低（OR 0.45；95% CI 0.25–0.79；p = .008）。