Saleh Fady, Jackson Timothy D, Ambrosini Luciano, Gnanasegaram Joshua J, Kwong Josephine, Quereshy Fayez, Okrainec Allan
Division of General Surgery, University Health Network, 399 Bathurst St, 8-MP 325A, Toronto, ON, M5T 2S8, Canada.
J Gastrointest Surg. 2014 Aug;18(8):1398-404. doi: 10.1007/s11605-014-2486-4. Epub 2014 Jun 10.
Recent evidence raises concern about the use of perioperative non-steroidal anti-inflammatory drug (NSAID) use after colorectal resection. The purpose of this retrospective cohort study was to investigate the relationship between perioperative ketorolac use and anastomotic leakage after colorectal surgery.
A retrospective review (2004-2011) was performed on patients who underwent elective colorectal surgery. Univariate analysis and multivariate logistic regression were used to evaluate the association between patients who did not receive any NSAIDs and those who received ketorolac within the first 5 days perioperatively and leak rate.
A total of 731 patients were identified as having resection with primary anastomosis: 376 (51.4 %) received no NSAIDs and 355 (48.6 %) received ketorolac perioperatively within 5 days after their surgery. There were 24 (3.3 %) leaks, with 12 in both the no NSAIDs (3.2 %) and ketorolac (3.4 %) groups, odds ratio (OR) 1.06 (0.43, 2.62; p = 0.886). Adjusting for smoking, steroid use, and age, there remained no significant difference between ketorolac use and leakage, OR 1.21 (0.52, 2.84; p = 0.660). In our multivariate model, only smoking was a significant predictor of postoperative leak, OR 3.34 (1.30, 8.62; p = 0.021).
There does not appear to be a significant association between perioperative ketorolac use and anastomotic leakage after colorectal surgery. However, further prospective studies are needed to confirm our findings before definitive guidelines on NSAID use perioperatively can be recommended.
近期证据引发了对结直肠切除术后围手术期使用非甾体抗炎药（NSAID）的担忧。这项回顾性队列研究的目的是调查结直肠手术后围手术期使用酮咯酸与吻合口漏之间的关系。
对接受择期结直肠手术的患者进行回顾性分析（2004 - 2011年）。采用单因素分析和多因素逻辑回归来评估未接受任何NSAIDs的患者与围手术期前5天内接受酮咯酸的患者之间的关联以及漏出率。
共确定731例患者进行了一期吻合切除术：376例（51.4%）未接受NSAIDs，355例（48.6%）在术后5天内围手术期接受了酮咯酸。有24例（3.3%）发生漏出，未接受NSAIDs组（3.2%）和酮咯酸组（3.4%）各有12例，比值比（OR）为1.06（0.43，2.62；p = 0.886）。在调整吸烟、使用类固醇和年龄因素后，使用酮咯酸与漏出之间仍无显著差异，OR为1.21（0.52，2.84；p = 0.660）。在我们的多因素模型中，只有吸烟是术后漏出的显著预测因素，OR为3.34（1.30，8.62；p = 0.021）。
结直肠手术后围手术期使用酮咯酸与吻合口漏之间似乎没有显著关联。然而，在能够推荐围手术期NSAIDs使用的明确指南之前，需要进一步的前瞻性研究来证实我们的发现。
