The Bowel Prep Conundrum

Extract

My prior essay in this section dissected recent European work that claimed an amazing surgical-site infection (SSI) prevention benefit of giving patients 80% oxygen by mask for a few hours perioperatively. Its authors proposed that using this simple adjunct halves SSI risk in colorectal operations. Besides addressing some specific methodology concerns, I asserted that the article had dubious impact on me because its authors had not used the “standard of care” in their control and treatment groups. The patients in both arms received no oral nonabsorbed antibiotic agents during preoperative preparation of the colon, but only systemic prophylactic agents. Local comments about my exegesis of the article were sparse. One of our research residents volunteered only that “mentioning your two dogs at the start of the article was cute”. A local surgeon, who casts a rather large shadow both literally and politically, displayed astonishing naiveté when he told me that “even if that oxygen work is valid, we will have to do the same number of operations that the article reported before any benefit could occur for our patients.”