Nonsteroidal Anti-inflammatory Drugs: Do They Increase the Risk of Anastomotic Leaks Following Colorectal Operations?

Dis Colon Rectum

1 Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, Michigan 2 Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan 3 Michigan Surgical Quality Collaborative, University of Michigan Health System, Ann Arbor, Michigan.

Published: September 2015

AI Article Synopsis

  • - The study assesses the impact of nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative complications, particularly anastomotic leaks, in colorectal surgery patients by comparing those who received NSAIDs on the first postoperative day to those who did not.
  • - Utilizing a large statewide database from Michigan, researchers used a rigorous method to adjust for various patient differences, ultimately analyzing data from 4,360 patients, of whom nearly 30% received NSAIDs post-surgery.
  • - Results showed no significant differences in rates of anastomotic leaks, surgical site infections, or 30-day mortality between the two groups; however, there was a higher incidence of sepsis among those who received NSAIDs.

Article Abstract

Background: Nonsteroidal anti-inflammatory drugs have become an important component of narcotic-sparing postoperative pain management protocols. However, conflicting evidence exists regarding the adverse association of nonsteroidal anti-inflammatory drug use with intestinal anastomotic healing in colorectal surgery.

Objective: This study compares patients receiving nonsteroidal anti-inflammatory drugs on postoperative day 1 with patients who did not receive nonsteroidal anti-inflammatory drugs with regard to the occurrence of anastomotic leaks.

Design: This is a retrospective study from a protocol-driven prospectively collected statewide database. A propensity score model was used to adjust for differences between the groups in patient demographics, characteristics, comorbidities, and laboratory values.

Settings: The multicenter data set used in this analysis represents a variety of academic and community hospitals within the state of Michigan from July 2012 through February 2014.

Patients: Nonpregnant patients over the age of 18 who underwent colon and rectal surgery with bowel anastomosis were selected.

Main Outcome Measures: Occurrence of anastomotic leak, composite surgical site infection, sepsis, and death within 30 days of surgery were the primary outcomes measured.

Results: A total of 4360 patients met inclusion criteria, of which 1297 (29.7%) received nonsteroidal anti-inflammatory drugs and 3063 (70.3%) did not receive nonsteroidal anti-inflammatory drugs. There was no statistically significant difference between the 2 groups in the proportion of cases with anastomotic leak (OR, 1.33; CI, 0.86-2.05; p = 0.20), composite surgical site infection (OR, 1.26; CI, 0.96-1.66; p = 0.09), or death within 30 days (OR, 0.58; CI, 0.28-1.19; p = 0.14). There was a significantly greater risk of sepsis for patients given nonsteroidal anti-inflammatory drugs than for those patients not given nonsteroidal anti-inflammatory drugs (OR, 1.47; CI, 1.05-2.06; p = 0.03).

Limitations: This is a nonrandomized study performed retrospectively, and it is based on data collected only within a subset of hospitals in the state of Michigan.

Conclusions: No statistically significant increase in the proportion of patients with anastomotic leak was observed when prescribing nonsteroidal anti-inflammatory drugs for analgesia in the early postoperative period for patients undergoing elective colorectal surgery. Unexpectedly, there was an increased risk of sepsis that warrants further investigation (see video, Supplemental Digital Content 1, http://links.lww.com/DCR/A192, for a synopsis of this study).

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Source
http://dx.doi.org/10.1097/DCR.0000000000000430DOI Listing

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