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

  • Aryan Modasi
  • David Pace
  • Marshall Godwin
  • Chris Smith
  • Bryan Curtis
Article

Abstract

Background

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.

Methods

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.

Results

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].

Conclusions

Great caution must be taken when prescribing NSAIDs following colonic or rectal anastomotic creation. The safety profile varies within the NSAID class and further research is needed to clarify which NSAIDs are safe for use and which are not.

Keywords

Early recovery after surgery (ERAS) Non-steroidal anti-inflammatory drugs (NSAIDs) Colorectal anastomosis Anastomotic leak 

Notes

Compliance with ethical standards

Disclosures

Drs. Aryan Modasi, David Pace, Marshall Godwin, Chris Smith, and Bryan Curtis have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General SurgeryMemorial University of NewfoundlandSt. John’sCanada
  2. 2.Department of Family Medicine and Clinical EpidemiologyMemorial University of NewfoundlandSt. John’sCanada
  3. 3.Department of Nephrology and Clinical EpidemiologyMemorial University of NewfoundlandSt. John’sCanada

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