NSAID administration post colorectal surgery increases anastomotic leak rate - systematic review/meta-analysis

Modasi, Aryan (2018) NSAID administration post colorectal surgery increases anastomotic leak rate - systematic review/meta-analysis. Masters thesis, Memorial University of Newfoundland.

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Background Current enhanced recovery guidelines suggest that opioid sparing medications should be used for analgesia whenever possible following colorectal surgery. The present study aims to assess whether postoperative NSAID use is associated with an increased anastomotic leak rate. Methods A systematic review was performed for studies investigating anastomotic leak rate following NSAID use versus control after colonic or rectal anastomosis. Meta-analysis was performed to assess for overall risk of anastomotic leak with NSAID use, as well as sub-group analysis to compare selective vs non-selective NSAIDs and drug-specific NSAID safety profiles. Results Seven studies were included in the final review. Use of an NSAID post-operatively was associated with an overall increased risk of anastomotic leakage [OR 1.58 (1.23, 2.03), P = 0.0003]. Non-selective NSAIDs were associated with an increased risk [OR 1.79 (1.47, 2.18), P < 0.00001], but selective NSAIDs were not. The non-selective NSAID diclofenac was associated with an increased leak rate [OR 2.79 (1.96, 3.96), P < 0.00001], but ketorolac was not [OR 1.36 (0.89, 2.06), P = 0.16]. Conclusions Great caution must be taken when prescribing NSAIDs following colonic or rectal anastomotic creation. The risk and safety profile varies within the NSAID class and further research is needed to clarify which NSAIDs are safe for use and which are not.

Item Type: Thesis (Masters)
URI: http://research.library.mun.ca/id/eprint/13076
Item ID: 13076
Additional Information: Includes bibliographical references (pages 59-63).
Keywords: NSAID, Nonsteroidal anti-inflammatory drugs, Anastomosis, Anastomotic Leak, Colorectal Surgery, ERAS, Early Recovery After Surgery
Department(s): Medicine, Faculty of
Date: May 2018
Date Type: Submission
Library of Congress Subject Heading: Colon (Anatomy) -- Surgery; Rectum -- Cancer; Rectum -- Surgery; Nonsteroidal anti-inflammatory agents
Medical Subject Heading: Colonic neoplasms -- surgery; Rectal neoplasms -- surgery; Anti-Inflammatory Agents, Non-Steroidal -- adverse effects; Anastomotic Leak -- prevention & control

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