title: Nonsteroidal Anti-inflammatory Drugs: Do They Increase the Risk of Anastomotic Leaks Following Colorectal Operations?
abstract: BACKGROUND
  Nonsteroidal anti-inflammatory drugs have become an important component of narcotic-sparing postoperative pain management protocols. However, conflicting evidence exists regarding the adverse association of nonsteroidal anti-inflammatory drug use with intestinal anastomotic healing in colorectal surgery.
  
  
  OBJECTIVE
  This study compares patients receiving nonsteroidal anti-inflammatory drugs on postoperative day 1 with patients who did not receive nonsteroidal anti-inflammatory drugs with regard to the occurrence of anastomotic leaks.
  
  
  METHODS
  This is a retrospective study from a protocol-driven prospectively collected statewide database. A propensity score model was used to adjust for differences between the groups in patient demographics, characteristics, comorbidities, and laboratory values.
  
  
  METHODS
  The multicenter data set used in this analysis represents a variety of academic and community hospitals within the state of Michigan from July 2012 through February 2014.
  
  
  METHODS
  Nonpregnant patients over the age of 18 who underwent colon and rectal surgery with bowel anastomosis were selected.
  
  
  METHODS
  Occurrence of anastomotic leak, composite surgical site infection, sepsis, and death within 30 days of surgery were the primary outcomes measured.
  
  
  RESULTS
  A total of 4360 patients met inclusion criteria, of which 1297 (29.7%) received nonsteroidal anti-inflammatory drugs and 3063 (70.3%) did not receive nonsteroidal anti-inflammatory drugs. There was no statistically significant difference between the 2 groups in the proportion of cases with anastomotic leak (OR, 1.33; CI, 0.86-2.05; p = 0.20), composite surgical site infection (OR, 1.26; CI, 0.96-1.66; p = 0.09), or death within 30 days (OR, 0.58; CI, 0.28-1.19; p = 0.14). There was a significantly greater risk of sepsis for patients given nonsteroidal anti-inflammatory drugs than for those patients not given nonsteroidal anti-inflammatory drugs (OR, 1.47; CI, 1.05-2.06; p = 0.03).
  
  
  CONCLUSIONS
  This is a nonrandomized study performed retrospectively, and it is based on data collected only within a subset of hospitals in the state of Michigan.
  
  
  CONCLUSIONS
  No statistically significant increase in the proportion of patients with anastomotic leak was observed when prescribing nonsteroidal anti-inflammatory drugs for analgesia in the early postoperative period for patients undergoing elective colorectal surgery. Unexpectedly, there was an increased risk of sepsis that warrants further investigation (see video, Supplemental Digital Content 1, http://links.lww.com/DCR/A192, for a synopsis of this study).
authors.affiliation: 1 Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, Michigan 2 Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan 3 Michigan Surgical Quality Collaborative, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Sylvester
authors.initials: S
authors.lastname: Paulasir
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Kaoutzanis
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Welch
authors.forename: James F
authors.initials: JF
authors.lastname: Vandewarker
authors.forename: Greta
authors.initials: G
authors.lastname: Krapohl
authors.forename: Richard M
authors.initials: RM
authors.lastname: Lampman
authors.forename: Michael G
authors.initials: MG
authors.lastname: Franz
authors.forename: Robert K
authors.initials: RK
authors.lastname: Cleary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000139:chemically induced*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000188:drug therapy; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000139:chemically induced; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal