Meta-analysis of efficacy of probiotics in reducing postoperative infections and improving outcomes in gastrointestinal surgery.

BACKGROUND

Postoperative infections remain a major cause of morbidity and mortality following gastrointestinal surgery. This meta-analysis aims to evaluate the efficacy of perioperative probiotic use in reducing postoperative infections (POI).

METHODS

Eight randomized controlled trials (RCTs) with 755 participants were included. The effect size was calculated as the Odds Ratio (OR) and Risk Ratio (RR) using a random-effects model.

RESULTS

The pooled analysis suggested a potential benefit in reducing overall postoperative infections [OR: 0.57 (95% CI: 0.32-1.01); P = 0.057] and wound infection [OR: 0.61 (95% CI: 0.35-1.06); P = 0.073]. While the overall effect narrowly missed statistical significance, subgroup analysis revealed a statistically significant reduction in POI when multi-strain Lactobacillus and Bifidobacterium formulations were used [RR: 0.64 (95% CI: 0.49-0.83)]. The absolute risk reduction (ARR) for this multi-strain subgroup was 13.5%, corresponding to a highly favorable number needed to treat (NNT) of 7.

CONCLUSION

The current evidence regarding the overall efficacy of perioperative probiotics in decreasing postoperative infectious complications narrowly misses statistical significance. However, the targeted use of multi-strain Lactobacillus and Bifidobacterium formulations significantly reduces the risk of infectious complications. These specific regimens offer a clinically meaningful benefit and support its inclusion in Enhanced Recovery After Surgery (ERAS) protocols for patients undergoing major gastrointestinal surgery.