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NSAID Use and Anastomotic Leaks Following Elective Colorectal Surgery: a Matched Case-Control Study

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Non-steroidal anti-inflammatory drugs (NSAIDs) decrease postoperative pain and opioid consumption. The objective of the study was to determine if postoperative NSAIDs were associated with anastomotic leaks following elective colorectal surgery.

Materials and Methods

We used a matched nested case-control study design. Using a prospectively collected database, we identified all patients having elective colorectal surgery between January 2001 and June 2012. Cases and matched controls were identified based on the occurrence of a postoperative anastomotic leak. The primary and secondary exposure variables were, respectively, use of any NSAID and use of ketorolac specifically. Conditional logistic regression was used to determine the unadjusted and adjusted odds ratio.

Results

A total of 262 patients were included (65.6 % inflammatory bowel disease, 34.4 % cancer). Use of any NSAID was associated with a non-significant increase in anastomotic leaks (odds ratio (OR) 1.81, 95 % confidence interval (CI) 0.98–3.37, p = 0.06). Use of ketorolac was associated with a significant increase in anastomotic leaks (OR 2.09, 95 % CI 1.12–3.89, p = 0.021). There was no significant association between anastomotic leaks and cumulative NSAID dose.

Conclusion

These data suggest that there may be an association between NSAIDs and risk of anastomotic leaks after colorectal surgery. Further research is needed to better elucidate this relationship to clarify the implications for patients.

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Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 1220, Toronto, ON, M5G 1X5, Canada

    Jhananiee Subendran, Robin S. McLeod & Anand Govindarajan

  2. Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

    Naveed Siddiqui

  3. Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    J. Charles Victor

  4. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

    Robin S. McLeod

Authors
  1. Jhananiee Subendran
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  2. Naveed Siddiqui
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  3. J. Charles Victor
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  4. Robin S. McLeod
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  5. Anand Govindarajan
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Corresponding author

Correspondence to Anand Govindarajan.

Additional information

Conference presentations: Material from this paper was presented at the Canadian Surgery Forum, the annual meeting of the Canadian Association of General Surgeons on Sep. 21, 2013 in Ottawa, Canada, and will be presented at the annual meeting of the Canadian Anesthesiologists Society in Jun, 2014 in St. John’s, Canada.

Dr. Mcleod holds the Angelo and Alfredo De Gasperis Families Chair in Colorectal Cancer and IBD Research.

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Subendran, J., Siddiqui, N., Victor, J.C. et al. NSAID Use and Anastomotic Leaks Following Elective Colorectal Surgery: a Matched Case-Control Study. J Gastrointest Surg 18, 1391–1397 (2014). https://doi.org/10.1007/s11605-014-2563-8

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  • DOI: https://doi.org/10.1007/s11605-014-2563-8

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