title: NSAID use and anastomotic leaks following elective colorectal surgery: a matched case-control study.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 1220, Toronto, ON, M5G 1X5, Canada.
authors.forename: Jhananiee
authors.initials: J
authors.lastname: Subendran
authors.forename: Naveed
authors.initials: N
authors.lastname: Siddiqui
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
authors.forename: Anand
authors.initials: A
authors.lastname: Govindarajan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000139:chemically induced*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal