title: Nonsteroidal anti-inflammatory drugs and the risk for anastomotic failure: a report from Washington State's Surgical Care and Outcomes Assessment Program (SCOAP).
abstract: OBJECTIVE
  Nonsteroidal anti-inflammatory drugs (NSAIDs) have many physiologic effects and are being used more commonly to treat postoperative pain, but recent small studies have suggested that NSAIDs may impair anastomotic healing in the gastrointestinal tract.
  
  
  OBJECTIVE
  To evaluate the relationship between postoperative NSAID administration and anastomotic complications.
  
  
  METHODS
  Retrospective cohort study of 13,082 patients undergoing bariatric or colorectal surgery at 47 hospitals in Washington State from January 1, 2006, through December 31, 2010, using data from the Surgical Care and Outcomes Assessment Program linked to the Washington State Comprehensive Abstract Reporting System.
  
  
  METHODS
  NSAID administration beginning within 24 hours after surgery.
  
  
  METHODS
  We used multivariate logistic regression modeling to assess the risk for anastomotic complications (reoperation, rescue stoma, revision of an anastomosis, and percutaneous drainage of an abscess) through 90 days after bariatric and colorectal surgery involving anastomoses.
  
  
  RESULTS
  Of the 13,082 patients (mean [SD] age, 58.1 [15.8] years; 60.7% women), 3158 (24.1%) received NSAIDs. The overall 90-day rate of anastomotic leaks was 4.3% for all patients (151 patients [4.8%] in the NSAID group and 417 patients [4.2%] in the non-NSAID group; P=.16). After risk adjustment, NSAIDs were associated with a 24% increased risk for anastomotic leak (odds ratio, 1.24 [95% CI, 1.01-1.56]; P=.04). This association was isolated to nonelective colorectal surgery, for which the leak rate was 12.3% in the NSAID group and 8.3% in the non-NSAID group (odds ratio, 1.70 [95% CI, 1.11-2.68]; P=.01).
  
  
  CONCLUSIONS
  Postoperative NSAIDs were associated with a significantly increased risk for anastomotic complications among patients undergoing nonelective colorectal resection. 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.
authors.affiliation: Department of Surgery, University of Washington Medical Center, Seattle.
authors.forename: Timo W
authors.initials: TW
authors.lastname: Hakkarainen
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Ft Lewis, Washington.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
authors.affiliation: Department of Surgery, Swedish Medical Center, Seattle, Washington.
authors.forename: Amir
authors.initials: A
authors.lastname: Bastaworous
authors.affiliation: Department of Surgery, University of Washington Medical Center, Seattle.
authors.forename: E Patchen
authors.initials: EP
authors.lastname: Dellinger
authors.affiliation: Department of General and Vascular Surgery, Providence Medical Center, Everett, Washington.
authors.forename: Ellen
authors.initials: E
authors.lastname: Farrokhi
authors.affiliation: Department of Surgery, University of Washington Medical Center, Seattle.
authors.forename: Farhood
authors.initials: F
authors.lastname: Farjah
authors.affiliation: Department of Surgery, Swedish Medical Center, Seattle, Washington.
authors.forename: Michael
authors.initials: M
authors.lastname: Florence
authors.affiliation: Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Scott
authors.initials: S
authors.lastname: Helton
authors.affiliation: Department of Surgery, Swedish Medical Center, Seattle, Washington.
authors.forename: Marc
authors.initials: M
authors.lastname: Horton
authors.affiliation: Department of Surgery, St Joseph Medical Center, Bellingham, Washington.
authors.forename: Michael
authors.initials: M
authors.lastname: Pietro
authors.affiliation: Department of Surgery, Harborview Medical Center, Seattle, Washington.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Varghese
authors.affiliation: Department of Surgery, University of Washington Medical Center, Seattle.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D050110:Bariatric Surgery / Q000009:adverse effects*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal