Skip to main content
SpringerLink
Log in

Perioperative Nonselective Non-steroidal Anti-inflammatory Drugs Are Not Associated with Anastomotic Leakage After Colorectal Surgery

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Recent evidence raises concern about the use of perioperative non-steroidal anti-inflammatory drug (NSAID) use after colorectal resection. The purpose of this retrospective cohort study was to investigate the relationship between perioperative ketorolac use and anastomotic leakage after colorectal surgery.

Methods

A retrospective review (2004–2011) was performed on patients who underwent elective colorectal surgery. Univariate analysis and multivariate logistic regression were used to evaluate the association between patients who did not receive any NSAIDs and those who received ketorolac within the first 5 days perioperatively and leak rate.

Results

A total of 731 patients were identified as having resection with primary anastomosis: 376 (51.4 %) received no NSAIDs and 355 (48.6 %) received ketorolac perioperatively within 5 days after their surgery. There were 24 (3.3 %) leaks, with 12 in both the no NSAIDs (3.2 %) and ketorolac (3.4 %) groups, odds ratio (OR) 1.06 (0.43, 2.62; p = 0.886). Adjusting for smoking, steroid use, and age, there remained no significant difference between ketorolac use and leakage, OR 1.21 (0.52, 2.84; p = 0.660). In our multivariate model, only smoking was a significant predictor of postoperative leak, OR 3.34 (1.30, 8.62; p = 0.021).

Conclusions

There does not appear to be a significant association between perioperative ketorolac use and anastomotic leakage after colorectal surgery. However, further prospective studies are needed to confirm our findings before definitive guidelines on NSAID use perioperatively can be recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 2008;248:189–198.

    Article  PubMed  Google Scholar 

  2. Raue W, Haase O, Junghans T, Scharfenberg M, Muller JM, Schwenk W. ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc 2004;18:1463–1468.

    Article  CAS  PubMed  Google Scholar 

  3. Eskicioglu C, Forbes SS, Aarts MA, Okrainec A, McLeod RS. Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. J Gastrointest Surg 2009;13:2321–2329.

    Article  PubMed  Google Scholar 

  4. Aarts MA, Okrainec A, Glicksman A, Pearsall E, Victor JC, McLeod RS. Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay. Surg Endosc 2012;26: 442–450.

    Article  PubMed  Google Scholar 

  5. White PF, Kehlet H. Improving postoperative pain management: what are the unresolved issues? Anesthesiology 2010;112:220–225.

    Article  PubMed  Google Scholar 

  6. Marret E, Kurdi O, Zufferey P, Bonnet F. Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology 2005;102:1249–1260.

    Article  CAS  PubMed  Google Scholar 

  7. Schlachta CM, Burpee SE, Fernandez C, Chan B, Mamazza J, Poulin EC. Optimizing recovery after laparoscopic colon surgery (ORAL-CS): effect of intravenous ketorolac on length of hospital stay. Surg Endosc 2007;21:2212–2219.

    Article  CAS  PubMed  Google Scholar 

  8. Chen J, Wu G, Mok M, Chou Y, Sun W, Chen P, Chan W, Yien H, Wen Y. Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients—a prospective, randomized, double-blind study. Acta Anaesthesiol Scand 2005;49(4):546–551.

    Article  CAS  PubMed  Google Scholar 

  9. Chen Y, Ko T, Wen Y, Wu S, Chou Y, Yien H, Kuo C. Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study. Clin J Pain 2009;25(6):485–489.

    Article  CAS  PubMed  Google Scholar 

  10. Burton TP, Mittal A, Soop M. Nonsteroidal anti-inflammatory drugs and anastomotic dehiscence in bowel surgery: systematic review and meta-analysis of randomized, controlled trials. Dis Colon Rectum 2013;56:126–134.

    Article  PubMed  Google Scholar 

  11. Holte K, Andersen J, Jakobsen DH, Kehlet H. Cyclo-oxygenase 2 inhibitors and the risk of anastomotic leakage after fast-track colonic surgery. Br J Surg 2009;96:650–654.

    Article  CAS  PubMed  Google Scholar 

  12. Gorissen KJ, Benning D, Berghmans T, Snoeijs MG, Sosef MN, Hulsewe KW, Luyer MD. Risk of anastomotic leakage with non-steroidal anti-inflammatory drugs in colorectal surgery. Br J Surg 2012;99:721–727.

    Article  CAS  PubMed  Google Scholar 

  13. Klein M, Andersen LP, Harvald T, Rosenberg J, Gogenur I. Increased risk of anastomotic leakage with diclofenac treatment after laparoscopic colorectal surgery. Dig Surg 2009;26:27–30.

    Article  CAS  PubMed  Google Scholar 

  14. Klein M, Gögenur I, Rosenberg J. Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data. BMJ 2012;345:e6166.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Rosenberg J, Harvald T. Severe complications with diclofenac after colonic resection. Dis Colon Rectm 2007;50:685.

    Article  Google Scholar 

  16. Kube R, Mroczkowski P, Granowski D, Benedix F, Sahm M, Schmidt U, Gastinger I, Lippert H, Study group Qualitätssicherung Kolon/Rektum-Karzinome. Anastomotic leakage after colon cancer surgery: a predictor of significant morbidity and hospital mortality, and diminished tumor-free survival. Eur J Surg Oncol 2010;36(2): 120–124.

    Article  CAS  PubMed  Google Scholar 

  17. Marra F, Steffen T, Kalak N, Warschkow R, Tarantino I, Lange J et al. Anastomotic leakage as a risk factor for the long-term outcome after curative resection of colon cancer. Eur J Surg Oncol 2009; 35:1060–1064.

    Article  CAS  PubMed  Google Scholar 

  18. Warner T, Giuliano F, Vojnovic I, Bukasa A, Mitchell J, Vane J. Nonsteroid drug selectivities for cyclo-oxygenase-1 rather than cyclo-oxygenase-2 are associated with human gastrointestinal toxicity: a full in vitro analysis. PNAS 1999;96:7563–7568.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Rushfeldt CF, Sveinbjørnsson B, Søreide K, Vonen B. Risk of anastomotic leakage with use of NSAIDs after gastrointestinal surgery. Int J Colorectal Dis 2011;26:1501–1509.

    Article  PubMed  Google Scholar 

  20. Schoenberger S, Kim S. Nonsteroidal anti-inflammatory drugs for retinal disease. Int J Inflam 2013: Article ID 281981. doi:10.1155/2013/281981.

    PubMed Central  PubMed  Google Scholar 

  21. Rothman K, Greenland S, Lash T. Modern epidemiology. Lippincott Williams and Wilkins, Philadelphia. 2008. Page 522.

    Google Scholar 

Download references

Conflict of Interest

No external sources were used to fund this project.

Author information

Authors and Affiliations

  1. Division of General Surgery, University Health Network, 399 Bathurst St, 8-MP 325A, Toronto, ON, M5T 2S8, Canada

    Fady Saleh, Timothy D. Jackson, Luciano Ambrosini, Joshua J. Gnanasegaram, Fayez Quereshy & Allan Okrainec

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Fady Saleh, Timothy D. Jackson, Josephine Kwong, Fayez Quereshy & Allan Okrainec

Authors
  1. Fady Saleh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy D. Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luciano Ambrosini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joshua J. Gnanasegaram
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Josephine Kwong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fayez Quereshy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Allan Okrainec
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allan Okrainec.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saleh, F., Jackson, T.D., Ambrosini, L. et al. Perioperative Nonselective Non-steroidal Anti-inflammatory Drugs Are Not Associated with Anastomotic Leakage After Colorectal Surgery. J Gastrointest Surg 18, 1398–1404 (2014). https://doi.org/10.1007/s11605-014-2486-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-014-2486-4

Keywords

Search

Navigation