228. EFFICACY AND SAFETY OF SELECTIVE DECONTAMINATION OF THE DIGESTIVE TRACT IN ESOPHAGEAL SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Abstract Background Esophagectomy is a complex surgical procedure with high morbidity and mortality mainly caused by postoperative infectious complications such as pneumonia and anastomotic leakage. Selective digestive decontamination (SDD) is a perioperative prophylactic non-absorbable antimicrobial strategy aimed to reduce postoperative infectious complications potentially lowering the density of pathogenic organisms in the oropharynx and esophagus. SDD has shown benefits in reducing infectious complications in intensive care units and lower gastrointestinal surgery. However, its efficacy and safety in patients undergoing esophagectomy is unclear, prompting this study to evaluate its perioperative use in these patients. Methods A systematic review and meta-analysis was conducted, including all study types regardless of design, by searching PubMed, Cochrane, Embase and Web of Science for publications up to October 2024. The primary outcome was efficacy, measured by the incidence of pneumonia, anastomotic leakage (AL), surgical site infection (SSI) and mortality. The secondary outcome was safety, measured by the occurrence of side effects and adverse events. The Cochrane risk of bias assessment tool and Newcastle-Ottawa quality assessment scale were used to assess risk of bias. Results Out of 616 articles screened, a total of 7 studies were included, with 487 patients in the SDD and 587 patients in the control group. SDD significantly reduced the incidence of pneumonia (odds ratio (OR) 0.42, 95% confidence interval (CI): 0.3–0.58, P < 0.01), anastomotic leakage (OR 0.43, 95% CI: 0.29–0.65, P < 0.01) and 30-day mortality (OR 0.25, 95% CI: 0.07 to 0.94; P = 0.04). No statistically significant difference was found regarding SSI (P = 0.20) and in hospital mortality (P = 0.28). Adverse events were scarcely reported, and those reported were mild, including an unpleasant taste and smell, sporadically resulting in nausea or vomiting. Conclusion This systematic review and meta-analysis, although composed of a limited number of studies, demonstrates that perioperative SDD reduces the risk of pneumonia, anastomotic leakage, and 30-day mortality following esophagectomy. Safety did not appear to be an issue, as the reported incidence of adverse events was minimal. However, none of the studies has provided systematic documentation of adverse events. Therefore, the evidence for SDD remains limited, highlighting the need for a large multicenter randomized controlled trial. To address this, the PERSuaDER trial is currently being conducted across Belgian and Dutch hospitals.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.034 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.039 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".