title: Increased risk for complications after colorectal surgery with selective cyclo-oxygenase 2 inhibitor etoricoxib.
abstract: BACKGROUND
  Cyclo-oxygenase 2 inhibitors can be used for pain treatment after colorectal surgery.
  
  
  OBJECTIVE
  The aim of this study was to investigate whether the use of etoricoxib has negative effects on the perioperative outcome in colorectal surgery.
  
  
  METHODS
  Complication data from an advanced medical database system were sampled prospectively, and patient records were reviewed retrospectively.
  
  
  METHODS
  All patients with elective colorectal surgery within an enhanced recovery after surgery protocol from 2008 to 2009 were selected.
  
  
  METHODS
  The nonrandomized use of perioperative etoricoxib treatment was compared with a control group.
  
  
  METHODS
  The primary outcome measured was the number of patients with postoperative complications according to the Dindo-Clavien classification.
  
  
  RESULTS
  One hundred one patients received etoricoxib treatment, whereas 104 did not. The patient groups were very comparable. We observed a significant increase in the number of patients with postoperative complications with etoricoxib treatment (43 vs 30 patients; 42.6% vs 28.8%, p = 0.041) due to an increase in patients with a major complication (Dindo-Clavien complication grade III-V: 22.8% vs 9.6%, p = 0.01). Patients with etoricoxib treatment and a complication needed a longer recovery period than patients with a complication in the control group (18 (17; 20) vs 14 (13; 15) days, p = 0.05). We observed an increased level of postoperative serum creatinine with etoricoxib treatment (105 (98; 112) vs 82 (78; 85), p = 0.003), which was more pronounced in patients with a complication (141 (127; 155) vs 91 (83; 98), p = 0.002; 25 vs 8 patients with serum creatinine >100 μmol/L, p = 0.008). In multivariate analysis, etoricoxib was identified as an independent risk factor for experiencing a major complication with a risk increase of approximately 2.5-fold (p = 0.03).
  
  
  CONCLUSIONS
  This study was limited by the nonrandomized use of perioperative etoricoxib and the retrospective nature of its review of patient records.
  
  
  CONCLUSIONS
  Etoricoxib increased the number of patients with postoperative complications and should be considered carefully in colorectal surgery.
authors: Hudiksvall Hospital, Department of Surgery, Colorectal Section, Hudiksvall, Sweden. tilman.zittel@lio.se
authors: Tilman T
authors: TT
authors: Zittel
authors: Dan
authors: D
authors: Razavi
authors: Andras
authors: A
authors: Papp
authors: Kjell
authors: K
authors: Lundberg
mesh_terms: D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects*; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000077613:Etoricoxib; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013450:Sulfones / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D011725:Pyridines; D013450:Sulfones; D000077613:Etoricoxib