Risk of anastomotic leakage with non-steroidal anti-inflammatory drugs in colorectal surgery

British Journal of Surgery, 04/19/2012

However, doubts have been raised concerning the safety of NSAIDs in terms of anastomotic healing. Non–selective NSAIDs may be associated with anastomotic leakage.

Methods

  • Data on patients who had undergone primary colorectal anastomosis at two teaching hospitals between January 2008 and December 2010 were analysed retrospectively.
  • Exact use of NSAIDs was recorded.
  • Rates of anastomotic leakage were compared between groups and corrected for known risk factors in both univariable and multivariable analyses.

Results

  • A total of 795 patients were divided into four groups according to NSAID use: no NSAIDs (471 patients), use of non–selective NSAIDs (201), use of selective cyclo–oxygenase (COX) 2 inhibitors (79), and use of both selective and non–selective NSAIDs (44).
  • The overall leak rate was 9•9 per cent (10•0 per cent for right colonic, 8•7 per cent for left colonic and 12•4 per cent for rectal anastomoses).
  • Known risk factors such as smoking and use of steroids were not significantly associated with anastomotic leakage.
  • Stapled anastomosis was identified as an independent predictor of leakage in multivariable analysis (odds ratio (OR) 2•22, 95 per cent confidence interval 1•30 to 3•80; P = 0•003).
  • Patients on NSAIDs had higher anastomotic leakage rates than those not on NSAIDs (13•2 versus 7•6 per cent; OR 1•84, 1•13 to 2•98; P = 0•010).
  • This effect was mainly due to non–selective NSAIDs (14•5 per cent; OR 2•13, 1•24 to 3•65; P = 0•006), not selective COX–2 inhibitors (9 per cent; OR 1•16, 0•49 to 2•75; P = 0•741).
  • The overall mortality rate was 4•2 per cent, with no significant difference between groups (P = 0•438).

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