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Postop NSAID Use May Increase Risk for Anastomotic Leak

Jennifer Garcia

January 22, 2015

Patients receiving nonsteroidal anti-inflammatory drugs (NSAIDs) after nonelective colorectal surgery had a 24%
increased risk for anastomotic leak in the 90-day postoperative period, according to a study published online
January 21 in JAMA Surgery.
"Given that other analgesic regimens are effective and well tolerated, these data may be enough for some surgeons
to alter practice patterns," write Timo W. Hakkarainen, MD, from the University of Washington Medical Center,
Seattle, and colleagues.
The researchers evaluated data from 13,082 patients across 47 Washington state hospitals who underwent bariatric
or colorectal surgery involving anastomosis between January 1, 2006, and December 31, 2010. Patient data were
recorded in the Surgical Care and Outcomes Assessment Program, which is linked to the Washington State
Comprehensive Abstract Reporting System. The majority of patients were women (60.7%), with a mean age of 58.1
years, and all patients were evaluated through 90 days after surgery.
Nearly one fourth (24.1%) of patients used NSAIDs, and the overall 90-day rate of anastomotic complications was
4.3% for all patients (4.8% in the NSAID group compared with 4.2% in the non-NSAID group; P = .16). Patients in
the NSAID group tended to be younger, had fewer comorbid conditions, and underwent elective procedures more
often than patients who did not receive NSAIDs.
The authors found that after controlling for covariates including patient age, sex, procedure type, and comorbid
conditions, there was a 24% increased risk for anastomotic leaks among patients who received NSAIDs after
surgery (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.01 - 1.56; P = .04). This complication was primarily
isolated to patients undergoing nonelective colorectal surgery, who experienced a leak rate of 12.3% in the NSAID
group vs 8.3% in the non-NSAID group (OR, 1.70; 95% CI, 1.11 - 2.68; P = .01). Overall, 12.4% of patients in the
entire group underwent nonelective colorectal surgery.
Although the researchers found there was no significant association between 90-day death and NSAID
administration, there was an association between increasing cardiac risk index and the risk for 90-day death, as well
as an association between cardiac events and risk for 90-day mortality.
The authors acknowledge limitations in the study, such as the lack of data on preoperative NSAID use as well as
which specific NSAIDs were administered, or the dose or duration of use. Given the general practice patterns of the
participating hospitals, however, the study authors hypothesize that nonselective NSAIDs were likely used in the
most cases.
"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," conclude Dr Hakkarainen and colleagues.
Funding for this study was provided by a grant from the Comparative Effective Research Translation Network, an
Agency for Healthcare Research and Qualityfunded initiative; by the Washington State Life Science Discovery
Fund; and by a grant from the National Institutes of Health. The authors have disclosed no relevant financial
relationships.
JAMA Surg. Published online January 21, 2015. Full text

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Cite this article: Postop NSAID Use May Increase Risk for Anastomotic Leak. Medscape. Jan 22, 2015.

http://www.medscape.com/viewarticle/838531_print

24/03/2015