title: Perioperative nonselective non-steroidal anti-inflammatory drugs are not associated with anastomotic leakage after colorectal surgery.
abstract: BACKGROUND
  Recent evidence raises concern about the use of perioperative non-steroidal anti-inflammatory drug (NSAID) use after colorectal resection. The purpose of this retrospective cohort study was to investigate the relationship between perioperative ketorolac use and anastomotic leakage after colorectal surgery.
  
  
  METHODS
  A retrospective review (2004-2011) was performed on patients who underwent elective colorectal surgery. Univariate analysis and multivariate logistic regression were used to evaluate the association between patients who did not receive any NSAIDs and those who received ketorolac within the first 5 days perioperatively and leak rate.
  
  
  RESULTS
  A total of 731 patients were identified as having resection with primary anastomosis: 376 (51.4 %) received no NSAIDs and 355 (48.6 %) received ketorolac perioperatively within 5 days after their surgery. There were 24 (3.3 %) leaks, with 12 in both the no NSAIDs (3.2 %) and ketorolac (3.4 %) groups, odds ratio (OR) 1.06 (0.43, 2.62; p = 0.886). Adjusting for smoking, steroid use, and age, there remained no significant difference between ketorolac use and leakage, OR 1.21 (0.52, 2.84; p = 0.660). In our multivariate model, only smoking was a significant predictor of postoperative leak, OR 3.34 (1.30, 8.62; p = 0.021).
  
  
  CONCLUSIONS
  There does not appear to be a significant association between perioperative ketorolac use and anastomotic leakage after colorectal surgery. However, further prospective studies are needed to confirm our findings before definitive guidelines on NSAID use perioperatively can be recommended.
authors.affiliation: Division of General Surgery, University Health Network, 399 Bathurst St, 8-MP 325A, Toronto, ON, M5T 2S8, Canada.
authors.forename: Fady
authors.initials: F
authors.lastname: Saleh
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
authors.forename: Luciano
authors.initials: L
authors.lastname: Ambrosini
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Gnanasegaram
authors.forename: Josephine
authors.initials: J
authors.lastname: Kwong
authors.forename: Fayez
authors.initials: F
authors.lastname: Quereshy
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
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* / Q000627:therapeutic use; D015331:Cohort Studies; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000009:adverse effects* / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010149:Postoperative Pain / Q000188:drug therapy; D019990:Perioperative Care / Q000009:adverse effects*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac