Nadeem N Haddad1, Brandon R Bruns, Toby M Enniss, David Turay, Joseph V Sakran, Alisan Fathalizadeh, Kristen Arnold, Jason S Murry, Matthew M Carrick, Matthew C Hernandez, Margaret H Lauerman, Asad J Choudhry, David S Morris, Jose J Diaz, Herb A Phelan, Martin D Zielinski. 1. From the Mayo Clinic, Department of Surgery, Division of Trauma, Critical Care and General Surgery (N.N.H., M.C.H., M.D.Z., A.J.C.), Rochester, Minnesota; University of Texas Health Science Center at San Antonio, Department of Surgery (N.N.H.), San Antonio, Texas; University of Maryland School of Medicine, Department of Surgery, Division of Acute Care Surgery (B.R.B., M.H.L., J.J.D.), Baltimore, Maryland; University of Utah, Department of Surgery, Division of General Surgery (T.M.E.), Salt Lake City, Utah; Loma Linda University, Department of Surgery, (D.T.), Loma Linda, California; Johns Hopkins University, Department of Surgery, Division of Acute Care Surgery (J.V.S.), Baltimore, Maryland; Einstein Medical Center, Department of Surgery (A.F.), Philadelphia, Pennsylvania; University of Texas Southwestern/Parkland Hospital, Department of Surgery, (K.A., H.A.P.), Dallas, Texas; East Texas Medical Center (J.S.M.), Alto, Texas; Medical Center of Plano (M.M.C.), Plano, Texas; and Intermountain Medical Center (D.S.M.), Murray, Utah.
Abstract
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used analgesic and anti-inflammatory adjuncts. Nonsteroidal anti-inflammatory drug administration may potentially increase the risk of postoperative gastrointestinal anastomotic failure (AF). We aim to determine if perioperative NSAID utilization influences gastrointestinal AF in emergency general surgery (EGS) patients undergoing gastrointestinal resection and anastomosis. METHODS: Post hoc analysis of a multi-institutional prospectively collected database was performed. Anastomotic failure was defined as the occurrence of a dehiscence/leak, fistula, or abscess. Patients using NSAIDs were compared with those without. Summary, univariate, and multivariable analyses were performed. RESULTS: Five hundred thirty-three patients met inclusion criteria with a mean (±SD) age of 60 ± 17.5 years, 53% men. Forty-six percent (n = 244) of the patients were using perioperative NSAIDs. Gastrointestinal AF rate between NSAID and no NSAID was 13.9% versus 10.7% (p = 0.26). No differences existed between groups with respect to perioperative steroid use (16.8% vs. 13.8%; p = 0.34) or mortality (7.39% vs. 6.92%, p = 0.84). Multivariable analysis demonstrated that perioperative corticosteroid (odds ratio, 2.28; 95% confidence interval, 1.04-4.81) use and the presence of a colocolonic or colorectal anastomoses were independently associated with AF. A subset analysis of the NSAIDs cohort demonstrated an increased AF rate in colocolonic or colorectal anastomosis compared with enteroenteric or enterocolonic anastomoses (30.0% vs. 13.0%; p = 0.03). CONCLUSION: Perioperative NSAID utilization appears to be safe in EGS patients undergoing small-bowel resection and anastomosis. Nonsteroidal anti-inflammatory drug administration should be used cautiously in EGS patients with colon or rectal anastomoses. Future randomized trials should validate the effects of perioperative NSAIDs use on AF. LEVEL OF EVIDENCE: Therapeutic study, level III.
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used analgesic and anti-inflammatory adjuncts. Nonsteroidal anti-inflammatory drug administration may potentially increase the risk of postoperative gastrointestinal anastomotic failure (AF). We aim to determine if perioperative NSAID utilization influences gastrointestinal AF in emergency general surgery (EGS) patients undergoing gastrointestinal resection and anastomosis. METHODS: Post hoc analysis of a multi-institutional prospectively collected database was performed. Anastomotic failure was defined as the occurrence of a dehiscence/leak, fistula, or abscess. Patients using NSAIDs were compared with those without. Summary, univariate, and multivariable analyses were performed. RESULTS: Five hundred thirty-three patients met inclusion criteria with a mean (±SD) age of 60 ± 17.5 years, 53% men. Forty-six percent (n = 244) of the patients were using perioperative NSAIDs. Gastrointestinal AF rate between NSAID and no NSAID was 13.9% versus 10.7% (p = 0.26). No differences existed between groups with respect to perioperative steroid use (16.8% vs. 13.8%; p = 0.34) or mortality (7.39% vs. 6.92%, p = 0.84). Multivariable analysis demonstrated that perioperative corticosteroid (odds ratio, 2.28; 95% confidence interval, 1.04-4.81) use and the presence of a colocolonic or colorectal anastomoses were independently associated with AF. A subset analysis of the NSAIDs cohort demonstrated an increased AF rate in colocolonic or colorectal anastomosis compared with enteroenteric or enterocolonic anastomoses (30.0% vs. 13.0%; p = 0.03). CONCLUSION: Perioperative NSAID utilization appears to be safe in EGS patients undergoing small-bowel resection and anastomosis. Nonsteroidal anti-inflammatory drug administration should be used cautiously in EGS patients with colon or rectal anastomoses. Future randomized trials should validate the effects of perioperative NSAIDs use on AF. LEVEL OF EVIDENCE: Therapeutic study, level III.
Authors: Federico Coccolini; Francesco Corradi; Massimo Sartelli; Raul Coimbra; Igor A Kryvoruchko; Ari Leppaniemi; Krstina Doklestic; Elena Bignami; Giandomenico Biancofiore; Miklosh Bala; Ceresoli Marco; Dimitris Damaskos; Walt L Biffl; Paola Fugazzola; Domenico Santonastaso; Vanni Agnoletti; Catia Sbarbaro; Mirco Nacoti; Timothy C Hardcastle; Diego Mariani; Belinda De Simone; Matti Tolonen; Chad Ball; Mauro Podda; Isidoro Di Carlo; Salomone Di Saverio; Pradeep Navsaria; Luigi Bonavina; Fikri Abu-Zidan; Kjetil Soreide; Gustavo P Fraga; Vanessa Henriques Carvalho; Sergio Faria Batista; Andreas Hecker; Alessandro Cucchetti; Giorgio Ercolani; Dario Tartaglia; Joseph M Galante; Imtiaz Wani; Hayato Kurihara; Edward Tan; Andrey Litvin; Rita Maria Melotti; Gabriele Sganga; Tamara Zoro; Alessandro Isirdi; Nicola De'Angelis; Dieter G Weber; Adrien M Hodonou; Richard tenBroek; Dario Parini; Jim Khan; Giovanni Sbrana; Carlo Coniglio; Antonino Giarratano; Angelo Gratarola; Claudia Zaghi; Oreste Romeo; Michael Kelly; Francesco Forfori; Massimo Chiarugi; Ernest E Moore; Fausto Catena; Manu L N G Malbrain Journal: World J Emerg Surg Date: 2022-09-21 Impact factor: 8.165