Do Perioperative Probiotics/Synbiotics Reduce Postoperative Infection Rates Following Elective Colorectal Surgery? A Systematic Review and Meta-Analysis

Abstract

Introduction: Postoperative infections remain common in elective colorectal surgery (CRS). Perioperative probiotics/synbiotics have been investigated as a strategy to optimize the intestinal microbiota and reduce postoperative infections. The aim of this study was to conduct an updated systematic review and meta-analysis on the efficacy of perioperative probiotics/synbiotics on postoperative infection rates following elective CRS. Methods: Six databases were searched on February 7, 2023, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines (International Prospective Register of Systematic Reviews: CRD420233392754). Inclusion criteria: randomized controlled trials comparing perioperative probiotics or synbiotics in colorectal resection for malignant or benign disease in patients > 18 y, reporting data on infectious complications within 30 d of surgery. Exclusion criteria: patients undergoing acute colorectal resection, nonrandomized controlled trials, prebiotics alone used as the intervention or control. The primary outcome measure was total postoperative infection rates within 30 d of elective CRS. Results: Twenty-eight randomized controlled trials involving 2686 participants demonstrated an association between probiotics/synbiotics and reduced rates of total postoperative infections within 30 d of elective CRS (relative risk 0.55, 95% confidence interval 0.41-0.74, P < 0.001). Conclusions: Perioperative probiotics/synbiotics are associated with almost halved total postoperative infection rates within 30 d of elective CRS. Further investigation into optimal regimens and the confounding effect of modern colorectal surgical practice is essential prior to implementation into clinical practice.