title: Effect of Perioperative Dexamethasone and Different NSAIDs on Anastomotic Leak Risk: A Propensity Score Analysis.
abstract: Perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with risk of anastomotic leak (AL). However, concomitant use of other drugs could infer a bias in risk assessment. Thus, we aimed to interrogate the risk of AL associated with NSAIDs and steroids used perioperatively.
  
  
  
  This study includes a consecutive series of patients having surgery involving an intestinal anastomosis from Jan 2007 to Dec 2009. Data records included demographic, perioperative, and surgical characteristics; AL rates; and use of NSAIDs and steroids. Risk of leak were estimated using unadjusted and multivariable (propensity score)-adjusted logistic regression models and reported as odds ratios (ORs).
  
  
  
  A total of 376 patients underwent 428 operations of which 67 (15.7 %) had AL. With no medication receivers as reference, the OR for leak when adjusted for age, sex, and propensity score was 1.07 (p = 0.92) for ketorolac, 1.63 (p = 0.31) for diclofenac and 0.41 (p = 0.19) for dexamethasone. Risk was increased for malignancy (OR 1.88, p = 0.023), use of a vasopressor (OR 2.52, p = 0.007), blood transfusions (OR 1.93, p = 0.026), and regular use of steroids (OR 7.57, p = 0.009).
  
  
  
  Other factors than perioperative drugs are crucial for risk of AL. Perioperative dexamethasone was associated with a nonsignificant reduced risk of AL.
authors.affiliation: Department of Gastrointestinal Surgery, Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, 9038, Tromsø, Norway. christian.rushfeldt@unn.no.
authors.forename: Christian Fredrik
authors.initials: CF
authors.lastname: Rushfeldt
authors.affiliation: Department of Surgery, Hospital of Hammerfest, 9600, Hammerfest, Norway.
authors.forename: Uwe Conrad
authors.initials: UC
authors.lastname: Agledahl
authors.affiliation: Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway.
authors.forename: Baldur
authors.initials: B
authors.lastname: Sveinbjørnsson
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, 4068, Stavanger, Norway.|Gastrointestinal Translational Research Unit, Laboratory for Molecular Biology, Stavanger University Hospital, 4068, Stavanger, Norway.|Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Søreide
authors.affiliation: Department of Community Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway.
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015331:Cohort Studies; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D012306:Risk
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003907:Dexamethasone