CER 128: Oral Mechanical Bowel Preparation for Colorectal Surgery
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Comparative Effectiveness Review Number 128 Oral Mechanical Bowel Preparation for Colorectal Surgery Comparative Effectiveness Review Number 128 Oral Mechanical Bowel Preparation for Colorectal Surgery Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2012-00012-I Prepared by: Brown University Evidence-based Practice Center Providence, RI Investigators: Issa J. Dahabreh, M.D., M.S. Dale W. Steele, M.D., M.S. Nishit Shah, M.D. Thomas A. Trikalinos, M.D., Ph.D. AHRQ Publication No. 14-EHC018-EF April 2014 This report is based on research conducted by the Brown University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00012-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This report may periodically be assessed for the urgency to update. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at: www.effectivehealthcare.ahrq.gov. Search on the title of the report. This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Suggested citation: Dahabreh IJ, Steele DW, Shah N, Trikalinos TA. Oral Mechanical Bowel Preparation for Colorectal Surgery. Comparative Effectiveness Review No. 128. (Prepared by the Brown University Evidence-based Practice Center under Contract No. 290-2012-00012-I.) AHRQ Publication No. 14-EHC018-EF. Rockville, MD: Agency for Healthcare Research and Quality; April 2014. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews can help clarify whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about AHRQ EPC systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm. AHRQ expects that these systematic reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input. We welcome comments on this systematic review. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Richard G. Kronick, Ph.D. Yen-pin Chiang, Ph.D. Director Acting Director, Center for Outcomes Agency for Healthcare Research and Quality and Evidence Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Director, EPC Program Elisabeth U. Kato, M.D., M.R.P. Center for Outcomes and Evidence Task Order Officer Agency for Healthcare Research and Quality Center for Outcomes and Evidence Agency for Healthcare Research and Quality iii Acknowledgments The authors would like to thank Dr. Cameron Platell (St. John of God Subiaco Hospital, Perth, Australia) for providing unpublished outcome data from a randomized trial included in this report; Dr. Mike Parker (Keyhole Surgery Ltd, Kent, United Kingdom) for providing clarifications regarding the mechanical preparation protocol for a randomized trial that was deemed ineligible for inclusion; and Dr. Shehzad Akbar Khan (Hayatabad Medical Complex, Peshawar, Pakistan) for providing access to study materials (reprints). The authors also acknowledge the individuals listed below for their contributions to this project: Key Informants In designing the study questions, the EPC consulted several Key Informants who represent the end-users of research. The EPC sought the Key Informant input on the priority areas for research and synthesis. Key Informants are not involved in the analysis of the evidence or the writing of the report. Therefore, in the end, study questions, design, methodological approaches, and/or conclusions do not necessarily represent the views of individual Key Informants. Key Informants must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their role as end-users, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who participated in developing this report follows: Fizan Abdullah, M.D., Ph.D. Robert Sawyer, M.D. Associate Professor of Surgery Professor of Surgery and Public Health Assistant Program Director, Residency in Sciences General Surgery Chief of Acute Care Surgery Associate Professor of International Health University of Virginia Health System Bloomberg School of Public Health Charlottesville, VA Program Director, Fellowship in Pediatric Surgery John Sperati, M.D. Johns Hopkins Children's Center Assistant Professor of Medicine Baltimore, MD Associate Program Director Osler Medical Residency Program Waleed Lutfiyya, M.D. Johns Hopkins Medical Institutions Kaiser Permanente Baltimore, MD Portland, OR Mark Welton, M.D. Laura Porter, M.D. Vice Chief of Staff, Stanford Hospital and Colon Cancer Alliance Clinics Washington, DC Professor of Surgery, Stanford University Medical School Stanford, CA iv Judy Zerzan, M.D., M.P.H. Chief Medical Officer/Deputy Medicaid Director Colorado Department of Health Care Policy and Financing Clinical Assistant Professor University of Colorado, Denver Denver, CO Technical Expert Panel In designing the study questions and methodology at the outset of this report, the EPC consulted several technical and content experts. Broad expertise and perspectives were sought. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts. Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who participated in developing this report follows: Michael Barza, M.D. Kamal Itani, M.D. Chief of Medicine and Program Director Professor of Surgery, Boston University Steward Carney Hospital Chief of General Surgery, Boston VA Vice Chairman for Clinical Affairs Health Care System Department of Medicine Boston, MA Tufts Medical Center Boston, MA Peter Mattei, M.D. Associate Professor of Surgery Nancy Baxter, M.D. University of Pennsylvania Associate Professor, Department of Surgery Attending Physician and Institute of Health Policy, Division of General, Thoracic and Fetal Management and Evaluation (IHPME) Surgery University of Toronto Children’s Hospital of Philadelphia Head, Division of General