Perioperative probiotics and synbiotics reduce postop infections in adults who undergo elective abdominal surgery

Reference

Chowdhury AH, Adiamah A, Kushairi A, et al. Perioperative probiotics or synbiotics in adults undergoing elective abdominal surgery. A systematic review and meta-analysis of randomized controlled trials. Ann Surg 2020;271(6):1036-1047.

Synopsis

These investigators thoroughly searched multiple databases including PubMed, EMBASE, the Cochrane Registry, and bibliographies of retrieved articles, and reviewed clinical trials registers. Eligible studies included randomized trials that evaluated perioperative probiotics or synbiotics (a combination of prebiotics—food ingredients that are not digested in the upper gastrointestinal tract and stimulate growth of selective bacteria in the colon—and probiotics) in adults, 18 years or older, who were undergoing elective abdominal surgery, including laparoscopic surgery. Two reviewers independently evaluated individual studies for inclusion criteria and methodologic quality using a standard risk-of-bias assessment tool. Discrepancies were resolved after discussion with a third reviewer. A total of 34 studies with 2723 participants met the inclusion criteria. The overall risk of bias was low to moderate. Perioperative probiotics or synbiotics significantly reduced the risk of postoperative infectious complications (relative risk = 0.56; 95% CI 0.46 - 0.69); the reduction was significantly greater with synbiotics than with probiotics alone. In a subgroup analysis, synbiotics also significantly reduced hospital lengths of stay. No significant differences in noninfectious complications or all-cause mortality occurred with the administration of either probiotics alone or synbiotics compared with standard control. Preparations were well-tolerated with no significant adverse events. Further analyses showed minimal evidence of heterogeneity of the results and a minimal risk of publication bias.