Clinical characteristics and risk factors of post-operative intestinal flora disorder following laparoscopic colonic surgery: A propensity-score-matching analysis

Table 1 The baseline characteristics of patients before and after propensity-score-matching, n (%)

Factors	Before PSM				After PSM
	Non-IFD (n = 976)	IFD (n = 97)	χ²	P value	Non-IFD (n = 194)	IFD (n = 97)	χ²	P value
Gender			6.831	0.009			0.000	1.000
Female	426 (43.6)	29 (29.9)			58 (29.9)	29 (29.9)
Male	550 (56.4)	68 (70.1)			136 (70.1)	68 (70.1)
Tumor locations			8.131	0.043			0.000	1.000
Asending colon	402 (41.2)	51 (52.6)			102 (52.6)	51 (52.6)
Transverse colon	63 (6.5)	7 (7.2)			14 (7.2)	7 (7.2)
Descending colon	395 (40.5)	25 (25.8)			50 (25.8)	25 (25.8)
Sigmoid colon	116 (11.8)	14 (14.4)			28 (14.4)	14 (14.4)
Age (yr)			2.060	0.151			0.063	0.801
< 65	499 (51.1)	57 (58.7)			111 (57.2)	57 (58.7)
≥ 65	477 (48.9)	40 (41.3)			83 (42.8)	40 (41.3)
ASA grade			1.336	0.248			0.248	0.619
I-II	888 (84.2)	86 (88.7)			168 (86.6)	86 (88.7)
III-IV	154 (15.8)	11 (11.3)			26 (13.4)	11 (11.3)
CEA			1.212	0.271			1.457	0.227
< 5 ng/mL	715 (73.3)	66 (68.1)			145 (77.7)	66 (68.1)
≥ 5 ng/mL	261 (26.7)	31 (31.9)			49 (22.3)	31 (31.9)
CA19-9			0.039	0.844			1.155	0.282
< 34 U/mL	852 (87.3)	84 (86.6)			176 (90.8)	84 (86.6)
≥ 34 U/mL	124 (22.7)	13 (13.5)			18 (9.2)	13 (13.5)
Hypertension (yes)	316 (32.4)	33 (34.0)	1.109	0.742	63 (32.5)	33 (34.0)	0.070	0.791
DM (yes)	198 (19.9)	18 (18.6)	0.098	0.755	26 (13.4)	18 (18.6)	1.339	0.247
CHD (yes)	98 (10.0)	10 (10.3)	0.007	0.933	10 (5.2)	10 (10.3)	2.685	0.101
Antiplatelet (yes)	89 (9.1)	9 (9.3)	0.003	0.956	10 (5.2)	9 (9.3)	1.802	0.179
Abdominal surgery (yes)	99 (10.1)	12 (12.4)	0.477	0.490	33 (17.1)	12 (12.4)	1.065	0.302

PSM: Propensity score matching; IFD: Intestinal flora disorder; ASA: American society of anesthesiologist; CEA: Carcino embryonic antigen; CA19-9: Carbohydrate antigen 19-9; DM: Diabetes mellitus; CHD: Coronary heart diseases.

Table 2 The clinical features and treatment strategies of intestinal flora disorder, n (%)

Clinical features	Statistics
The first symptoms at the diagnosis of IFD
Abdominal distension	38 (39.1)
Diarrhea	50 (51.6)
Fever	8 (8.3)
Septic shock	1 (1.0)
The occurrence timepoint of IFD
POD 1-2	15 (15.4)
POD 3-4	48 (49.6)
POD 5-6	34 (36.0)
The routin stool tests (Yes/No)	63/34
The results of stool test (WBC/HPF)
0-1	23 (36.6)
2-5	8 (12.7)
6-10	10 (15.9)
11-15	5 (7.9)
> 15	17 (26.9)
The detection of Clostridium difficile (Yes/No)	51/47
The results of Clostridium test (Positive/Negative)	15/36
Intestinal flora treatment (Yes/No)	88/9
Oral norvancomycin (Yes/No)	72/25
The duration of oral rvancomycin
1-4 d	41 (56.9)
5-7 d	21 (29.2)
> 7 d	10 (13.9)
Venous vancomycin (Yes/No)	33/64
The duration of venous vancomycin
1-4 d	15 (45.4)
5-7 d	13 (39.4)
> 7 d	5 (15.2)
The insertion of gastric tube (Yes/No)	23/74
The timepoint of insertion
POD 1-3	6 (26.1)
POD 4-6	17 (73.9)
The duration of gastric tube
1-3 d	16 (69.6)
4-7 d	7 (30.4)
The insertion of ileus tube (Yes/No)	11/86
The timepoint of insertion
POD 5-7	4 (36.4)
POD 7-12	7 (63.6)
The duration of ileus tube
4 d	7 (63.6)
6 d	2 (18.2)
≥ 7 d	2 (18.2)

IFD: Intestinal flora disorder; PSM: Propensity score matching; POD: Post-operative day; WBC: White blood cell; HPF: High power field.

Table 3 Uni-variate analysis after propensity score matching

Factors	IFD (n = 97)	Non-IFD (n = 194)	χ²	OR (95%CI)	P value
Age (< 65/≥ 65 yr)	57/40	110/84	0.112	1.09 (0.66-1.78)	0.737
BMI (< 24/≥ 24 kg/m2)	51/46	105/89	0.062	0.94 (0.58-1.53)	0.803
The systom of obstruction (No/Yes)	70/27	153/41	1.622	0.69 (0.40-1.22)	0.203
Total colonscopy (No/Yes)	43/54	73/121	1.211	1.32 (0.80-2.16)	0.271
The CFR occupation (≥ 1/2/< 1/2)	63/34	131/63	0.193	0.89 (0.53-1.49)	0.660
Neoadjuvant therapy (No/Yes)	91/6	181/11	0.031	0.91 (0.33-2.54)	0.860
Colonscopy pre-surgery (No/Yes)	71/26	151/43	0.769	0.78 (0.44-1.37)	0.380
Re-location pre-surgery (No/Yes)	76/21	166/28	2.405	0.61 (0.33-1.14)	0.121
Polypectomy pre-surgery (No/Yes)	83/14	172/22	0.571	0.76 (0.37-1.56)	0.450
Obstruction pre-surgery (No/Yes)	83/14	185/9	8.521	0.29 (0.12-0.69)	0.004
PGEP (1-2/3 packages)	63/34	139/55	1.368	1.36 (0.81-2.30)	0.243
Cephingosporins pre-surgery (No/Yes)	87/10	159/35	2.957	1.92 (0.90-4.05)	0.085
Metronidazole pre-surgery (No/Yes)	49/48	134/60	9.541	0.46 (0.28-0.75)	0.002
Operation duration (≥ 130/< 130 min)	48/49	102/92	0.248	0.88 (0.54-1.44)	0.619
Total blood loss (≥ 20/< 20 mL)	66/31	138/56	0.295	0.86 (0.51-1.46)	0.587
Stoma (No/Yes)	93/4	192/2	1.723	0.24 (0.04-1.35)	0.189
Antibotics post-surgery (No/Yes)	79/18	187/7	18.401	0.16 (0.07-0.41)	< 0.001
Nutrition supply pre-surgery, n (%)			33.880		< 0.001
EN	42 (43.3)	37 (19.1)		1 (Refrence)
PN	17 (17.5)	99 (51.0)		6.61(3.35-13.03)
GNS	38 (39.2)	58 (29.9)		1.73 (0.95-3.16)

IFD: Intestinal flora disorder; BMI: Body mass index; CFR: Circumferential range; PGEP: Polyethylene glycol electrolytes powder; EN: Enteral nutrition; PN: Parenteral nutrition; GNS: Glucose and sodium chloride injection.