Open AccessEffect of Perioperative Dexamethasone and Different NSAIDs on Anastomotic Leak Risk: A Propensity Score Analysis
Author(s) -
Rushfeldt Christian Fredrik,
Agledahl Uwe Conrad,
Sveinbjørnsson Baldur,
Søreide Kjetil,
Wilsgaard Tom
Publication year - 2016
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-016-3620-0
Subject(s) - medicine , perioperative , propensity score matching , ketorolac , odds ratio , abdominal surgery , diclofenac , dexamethasone , anesthesia , surgery , analgesic
Background 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. Methods 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). Results 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). Conclusions Other factors than perioperative drugs are crucial for risk of AL. Perioperative dexamethasone was associated with a nonsignificant reduced risk of AL.