Bowel Preparation for Colostomy Reversal in Children

Infographic · May 2019 · 1 min read

In brief

This retrospective study of 61 children undergoing colostomy reversal found that omitting preoperative bowel preparation reduced time to surgery and hospital length of stay without increasing complications or readmissions. The findings suggest bowel prep may be unnecessary for pediatric colostomy closure.

62% of children undergoing colostomy reversal received no preoperative bowel preparation without increased complications
Bowel preparation increased time to surgery (19h vs 3h) and hospital stay (6 days vs 5 days) compared to no preparation
Complication rates and 90-day readmissions were similar whether bowel prep was used or omitted
Skipping bowel preparation may reduce costs and morbidity in pediatric colostomy closure without compromising safety
Most common indication for colostomy was anorectal malformation (61% of cases)

Written by the GCMD Library team from the infographic.

The infographic uses a blue color scheme with white icons representing bowels, calendars, clocks, hospitals, and surgical tools. The layout flows left to right, showing two patient groups (bowel prep and no prep) with their respective outcome metrics displayed in boxes. Statistical significance is indicated with p-values beneath each metric.

Pediatric bowel preparation protocols used before colostomy reversal vary. The aim of this study is to determine institutional practices at our institution and evaluate the impact of bowel preparations on postoperative outcomes and hospital length of stay in children.

Methods

This was a retrospective review of children ≤18 years old undergoing colostomy reversal at Texas Children's Hospital (TCH) between 12/2013 and 8/2017. Preoperative bowel regimens and outcomes were collected and analyzed using descriptive statistics, Wilcoxon Rank-Sum and Fishers Exact tests. Continuous variables are presented as median [IQR].

Results

Sixty-one children underwent colostomy reversal. Thirty-eight (62%) did not receive a preoperative bowel preparation. The two cohorts were similar in age, gender, and race. The most common indication for colostomy was anorectal malformation for thirty-seven (61%). Time from admission to surgery (19 h [17, 23] vs 3 [2, 3]; p < 0.01) and HLOS (6 days [5, 8] vs 5 [4, 6]; p = 0.02) were both longer in the bowel preparation cohort. Complications (3 [13%] vs 5 [22%]; p = 0.12) and 90-day readmissions (3 [13%] vs 6 [16%]; p = 0.64) were similar in both cohorts.

Conclusion

Foregoing bowel preparation may have the potential to improve cost and reduce morbidity in children undergoing colostomy closure.

Level of evidence

III.

Study type

Treatment study.

Visual abstract created by Alejandra M Casar Berazaluce, MD - Pediatric Surgery Research Fellow at Cincinnati Children's Hospital Medical Center.

The text in the image

Bowel Prep for Colostomy Reversal in Children | Retrospective Cohort | Patients <18y old | 2014 - 2017 | n=61 | BOWEL PREP | n=23 | (38%) | NO PREP | n=38 | (62%) | Length of Stay | 6d | p=0.02 | 5d | Time to OR | 19hr | p<0.01 | 3hr | Hospital Readmission | 13% | p=0.64 | 16% | Additional Surgery | 4% | p=1.00 | 3% | Complications (60 days) | 5 | Wound(3) Leak(1) SBO(1) | p=0.12 (p=0.36-1.00) | 3 | Wound(2) Abscess(1) | *NO DIFFERENCE* | Journal of Pediatric Surgery | Rosenfeld et al. Journal of Pediatric Surgery (2019) | https://doi.org/10.1016/j.jpedsurg.2019.01.037 | @alejandracasar

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