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Nonsteroidal anti‐inflammatory drugs and anastomotic dehiscence after colorectal surgery: a meta‐analysis
Author(s) -
Huang Yeqian,
Tang Stephen R.,
Young Christopher J.
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14322
Subject(s) - medicine , dehiscence , meta analysis , odds ratio , colorectal surgery , randomized controlled trial , anastomosis , cochrane library , surgery , confidence interval , subgroup analysis , nonsteroidal , abdominal surgery
Background Enhanced recovery after surgery protocols supports the post‐operative use of nonsteroidal anti‐inflammatory drugs (NSAIDs) to minimize the use of opioids. However, there is an increasing concern on the impaired wound healing of anastomosis associated with NSAID use, potentially causing a higher risk of anastomotic leakage. The aim was to conduct a meta‐analysis to evaluate the association of NSAIDs with anastomotic leakage after colorectal surgery. Methods A literature search was conducted using the MEDLINE, PubMed, Cochrane Library and Clinicaltrial.gov . Studies identified were appraised with standard selection criteria. Data points were extracted and meta‐analysis was performed based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. Results Seventeen studies comprising of 26 098 patients were examined. The analysis of all studies showed a significantly lower rate of anastomotic dehiscence in the no‐NSAID group (pooled odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.48–2.71, P < 0.00001). The analysis of randomized controlled trials (RCTs) demonstrates similar dehiscence rates between both groups ( P = 0.17). In subgroup analysis , non‐selective NSAIDs was associated with a higher risk of anastomotic dehiscence (pooled OR = 2.02, 95% CI = 1.62–2.50, P < 0.00001). However, there was no difference in the incidence of anastomotic leakage between no‐NSAID group and selective NSAID group ( P = 0.05). Conclusion Use of NSAIDs after colorectal surgery may be associated with a higher risk of anastomotic leakage. It is important to balance between the benefits of faster post‐operative recovery and potential adverse effects of NSAIDs. Selective NSAIDs may be safer than non‐selective ones. More RCTs are warranted to further evaluate the relationship between anastomotic leakage and use of NSAIDs, especially selective ones.