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

Abstract

Background: With the implementation of multimodal analgesia regimens in fast-track surgery programmes, non-steroidal anti-inflammatory drugs (NSAIDs) are being prescribed routinely. However, doubts have been raised concerning the safety of NSAIDs in terms of anastomotic healing. 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). Conclusion: Non-selective NSAIDs may be associated with anastomotic leakage.