title: Non-Steroidal Anti-Inflammatory Drug Use and Risk of Anastomotic Leakage after Anterior Resection: A Protocol-Based Study.
abstract: BACKGROUND
  Non-steroidal anti-inflammatory drugs (NSAIDs) have been introduced as opioid-sparing analgesics in colorectal surgery. However, recent research has implicated these drugs as risk factors for anastomotic dehiscence.
  
  
  METHODS
  The Swedish Colorectal Cancer Registry was used to identify all patients operated with anterior resection for rectal cancer at centres that performed more than 25 abdominal operations per year, from 2007 to 2012, inclusive. The registry provided individual patient data on demographic variables and symptomatic anastomotic leakage. The patient exposure to NSAIDs was defined according to the protocol of the hospital at which the patient was operated. Logistic regression was employed to estimate ORs and 95% CIs, adjusting for confounders.
  
  
  RESULTS
  The study cohort comprised 2,605 patients operated at 21 centres. In the NSAID group, 102/1,458 (7.0%) suffered an anastomotic leak, as compared to 124/1,023 (10.8%) in the non-NSAID group. With adjustment for confounding, patients treated at NSAID hospitals had a reduced risk of developing anastomotic leakage (OR 0.68; 95% CI 0.48-0.96).
  
  
  CONCLUSIONS
  In this retrospective protocol-based study, NSAIDs did not increase the risk of anastomotic leakage after anterior resection for rectal cancer. The postoperative use of NSAIDs may not be detrimental, but more research is warranted.
authors.affiliation: Department of Surgical and Perioperative Sciences, Umex00E5; University, Umex00E5;, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Rutegård
authors.forename: Sofia
authors.initials: S
authors.lastname: Westermark
authors.forename: Daniel
authors.initials: D
authors.lastname: Kverneng Hultberg
authors.forename: Markku
authors.initials: M
authors.lastname: Haapamäki
authors.forename: Peter
authors.initials: P
authors.lastname: Matthiessen
authors.forename: Jörgen
authors.initials: J
authors.lastname: Rutegård
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000139:chemically induced*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal