Timo W Hakkarainen1, Scott R Steele2, Amir Bastaworous3, E Patchen Dellinger1, Ellen Farrokhi4, Farhood Farjah1, Michael Florence3, Scott Helton5, Marc Horton3, Michael Pietro6, Thomas K Varghese7, David R Flum1. 1. Department of Surgery, University of Washington Medical Center, Seattle. 2. Department of Surgery, Madigan Army Medical Center, Ft Lewis, Washington. 3. Department of Surgery, Swedish Medical Center, Seattle, Washington. 4. Department of General and Vascular Surgery, Providence Medical Center, Everett, Washington. 5. Department of Surgery, Virginia Mason Medical Center, Seattle, Washington. 6. Department of Surgery, St Joseph Medical Center, Bellingham, Washington. 7. Department of Surgery, Harborview Medical Center, Seattle, Washington.
Abstract
IMPORTANCE: Nonsteroidal anti-inflammatory drugs (NSAIDs) have many physiologic effects and are being used more commonly to treat postoperative pain, but recent small studies have suggested that NSAIDs may impair anastomotic healing in the gastrointestinal tract. OBJECTIVE: To evaluate the relationship between postoperative NSAID administration and anastomotic complications. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 13,082 patients undergoing bariatric or colorectal surgery at 47 hospitals in Washington State from January 1, 2006, through December 31, 2010, using data from the Surgical Care and Outcomes Assessment Program linked to the Washington State Comprehensive Abstract Reporting System. EXPOSURE: NSAID administration beginning within 24 hours after surgery. MAIN OUTCOMES AND MEASURES: We used multivariate logistic regression modeling to assess the risk for anastomotic complications (reoperation, rescue stoma, revision of an anastomosis, and percutaneous drainage of an abscess) through 90 days after bariatric and colorectal surgery involving anastomoses. RESULTS: Of the 13,082 patients (mean [SD] age, 58.1 [15.8] years; 60.7% women), 3158 (24.1%) received NSAIDs. The overall 90-day rate of anastomotic leaks was 4.3% for all patients (151 patients [4.8%] in the NSAID group and 417 patients [4.2%] in the non-NSAID group; P=.16). After risk adjustment, NSAIDs were associated with a 24% increased risk for anastomotic leak (odds ratio, 1.24 [95% CI, 1.01-1.56]; P=.04). This association was isolated to nonelective colorectal surgery, for which the leak rate was 12.3% in the NSAID group and 8.3% in the non-NSAID group (odds ratio, 1.70 [95% CI, 1.11-2.68]; P=.01). CONCLUSIONS AND RELEVANCE: Postoperative NSAIDs were associated with a significantly increased risk for anastomotic complications among patients undergoing nonelective colorectal resection. To determine the role of NSAIDs in colorectal surgery, future evaluations should consider specific formulations, the dose effect, mechanism, and other relevant outcome domains, including pain control, cardiac complications, and overall recovery.
IMPORTANCE: Nonsteroidal anti-inflammatory drugs (NSAIDs) have many physiologic effects and are being used more commonly to treat postoperative pain, but recent small studies have suggested that NSAIDs may impair anastomotic healing in the gastrointestinal tract. OBJECTIVE: To evaluate the relationship between postoperative NSAID administration and anastomotic complications. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 13,082 patients undergoing bariatric or colorectal surgery at 47 hospitals in Washington State from January 1, 2006, through December 31, 2010, using data from the Surgical Care and Outcomes Assessment Program linked to the Washington State Comprehensive Abstract Reporting System. EXPOSURE: NSAID administration beginning within 24 hours after surgery. MAIN OUTCOMES AND MEASURES: We used multivariate logistic regression modeling to assess the risk for anastomotic complications (reoperation, rescue stoma, revision of an anastomosis, and percutaneous drainage of an abscess) through 90 days after bariatric and colorectal surgery involving anastomoses. RESULTS: Of the 13,082 patients (mean [SD] age, 58.1 [15.8] years; 60.7% women), 3158 (24.1%) received NSAIDs. The overall 90-day rate of anastomotic leaks was 4.3% for all patients (151 patients [4.8%] in the NSAID group and 417 patients [4.2%] in the non-NSAID group; P=.16). After risk adjustment, NSAIDs were associated with a 24% increased risk for anastomotic leak (odds ratio, 1.24 [95% CI, 1.01-1.56]; P=.04). This association was isolated to nonelective colorectal surgery, for which the leak rate was 12.3% in the NSAID group and 8.3% in the non-NSAID group (odds ratio, 1.70 [95% CI, 1.11-2.68]; P=.01). CONCLUSIONS AND RELEVANCE: Postoperative NSAIDs were associated with a significantly increased risk for anastomotic complications among patients undergoing nonelective colorectal resection. To determine the role of NSAIDs in colorectal surgery, future evaluations should consider specific formulations, the dose effect, mechanism, and other relevant outcome domains, including pain control, cardiac complications, and overall recovery.
Authors: T H Lee; E R Marcantonio; C M Mangione; E J Thomas; C A Polanczyk; E F Cook; D J Sugarbaker; M C Donaldson; R Poss; K K Ho; L E Ludwig; A Pedan; L Goldman Journal: Circulation Date: 1999-09-07 Impact factor: 29.690
Authors: Joseph C Carmichael; Deborah S Keller; Gabriele Baldini; Liliana Bordeianou; Eric Weiss; Lawrence Lee; Marylise Boutros; James McClane; Scott R Steele; Liane S Feldman Journal: Surg Endosc Date: 2017-08-03 Impact factor: 4.584
Authors: Meera Kotagal; Timo W Hakkarainen; Vlad V Simianu; Sara J Beck; Rafael Alfonso-Cristancho; David R Flum Journal: Ann Surg Date: 2016-01 Impact factor: 12.969
Authors: Aurélien Venara; Emilie Duchalais; Anne Dariel; Philippe Aubert; Tony Durand; Guillaume Meurette; Malvyne Rolli-Derkinderen; Antoine Hamy; Michel Neunlist Journal: World J Surg Date: 2018-04 Impact factor: 3.352