NSAID administration post colorectal surgery increases anastomotic leak rate: systematic review/meta-analysis

Surgical Endoscopy
Aryan ModasiBryan Curtis

Abstract

Current enhanced recovery guidelines suggest that opioid sparing medications should be used for analgesia whenever possible following colorectal surgery. The present study aims to assess whether post-operative NSAID use is associated with an increased anastomotic leak rate after a colonic or rectal anastomosis. A systematic review was performed for studies investigating anastomotic leak rate following NSAID use vs control after colonic or rectal anastomosis. Meta-analysis was performed to assess for overall risk of anastomotic leak with NSAID use, as well as sub-group analysis to compare selective vs non-selective NSAIDs and drug-specific NSAID safety profiles. Seven studies were included in the final review. Use of an NSAID post-operatively was associated with an overall increased risk of anastomotic leakage [OR 1.58 (1.23, 2.03), P = 0.0003]. Non-selective NSAIDs were associated with an increased risk [OR 1.79 (1.47, 2.18), P < 0.00001], but selective NSAIDs were not. The non-selective NSAID diclofenac was associated with an increased leak rate [OR 2.79 (1.96, 3.96), P < 0.00001], but ketorolac was not [OR 1.36 (0.89, 2.06), P = 0.16]. Great caution must be taken when prescribing NSAIDs following colonic or rectal anastomotic...Continue Reading

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Citations

Oct 10, 2019·The British Journal of Surgery·UNKNOWN EuroSurg Collaborative
May 30, 2020·Anesthesia and Analgesia·Tong J GanBeverly K Philip
Apr 23, 2020·International Journal of Colorectal Disease·Margaretha LindbergKarl A Franklin
Aug 18, 2020·Langenbeck's Archives of Surgery·Stefan ReischlPhilipp-Alexander Neumann
Jan 7, 2020·The British Journal of Surgery·C Small, H Laycock
Sep 14, 2019·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Angela MujukianKaren Zaghiyan
Apr 29, 2020·The Journal of Thoracic and Cardiovascular Surgery·Erin M CorsiniUNKNOWN MD Anderson Esophageal Cancer Working Group
Sep 28, 2020·The Annals of Thoracic Surgery·Erin M CorsiniWayne L Hofstetter
Mar 1, 2020·Journal of the American College of Surgeons·John W KunstmanRonald R Salem
Jul 19, 2020·Best Practice & Research. Clinical Obstetrics & Gynaecology·Caitlin Anne JagoSukhbir S Singh
Mar 17, 2021·AACN Advanced Critical Care·Shanna Fortune, Jennifer Frawley
Aug 15, 2020·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·Melissa N N ArronRichard P G Ten Broek
Apr 4, 2021·Healthcare·Sara J HylandRobert K Cleary
Jun 3, 2021·Journal of Clinical Medicine·Stephan A Schug
Jun 9, 2021·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·S L KastoraP K Myint
Jun 16, 2021·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·Annabel S Zaat, Hermien W H Schreurs
Jun 14, 2021·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·Melissa N N Arron
Jul 18, 2021·Pain and Therapy·Filomena PuntilloGiustino Varrassi

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