Subendran Jhananiee, Siddiqui Naveed, Victor J Charles, McLeod Robin S, Govindarajan Anand
Division of General Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 1220, Toronto, ON, M5G 1X5, Canada.
J Gastrointest Surg. 2014 Aug;18(8):1391-7. doi: 10.1007/s11605-014-2563-8. Epub 2014 Jun 10.
Non-steroidal anti-inflammatory drugs (NSAIDs) decrease postoperative pain and opioid consumption. The objective of the study was to determine if postoperative NSAIDs were associated with anastomotic leaks following elective colorectal surgery.
We used a matched nested case-control study design. Using a prospectively collected database, we identified all patients having elective colorectal surgery between January 2001 and June 2012. Cases and matched controls were identified based on the occurrence of a postoperative anastomotic leak. The primary and secondary exposure variables were, respectively, use of any NSAID and use of ketorolac specifically. Conditional logistic regression was used to determine the unadjusted and adjusted odds ratio.
A total of 262 patients were included (65.6 % inflammatory bowel disease, 34.4 % cancer). Use of any NSAID was associated with a non-significant increase in anastomotic leaks (odds ratio (OR) 1.81, 95 % confidence interval (CI) 0.98-3.37, p = 0.06). Use of ketorolac was associated with a significant increase in anastomotic leaks (OR 2.09, 95 % CI 1.12-3.89, p = 0.021). There was no significant association between anastomotic leaks and cumulative NSAID dose.
These data suggest that there may be an association between NSAIDs and risk of anastomotic leaks after colorectal surgery. Further research is needed to better elucidate this relationship to clarify the implications for patients.
非甾体抗炎药（NSAIDs）可减轻术后疼痛并减少阿片类药物的使用。本研究的目的是确定选择性结直肠手术后使用NSAIDs是否与吻合口漏相关。
我们采用了匹配的巢式病例对照研究设计。利用前瞻性收集的数据库，我们确定了2001年1月至2012年6月期间所有接受选择性结直肠手术的患者。根据术后吻合口漏的发生情况确定病例和匹配对照。主要和次要暴露变量分别为是否使用任何NSAIDs以及是否专门使用酮咯酸。采用条件逻辑回归来确定未调整和调整后的比值比。
共纳入262例患者（65.6%为炎症性肠病，34.4%为癌症）。使用任何NSAIDs与吻合口漏的非显著性增加相关（比值比（OR）为1.81，95%置信区间（CI）为0.98 - 3.37，p = 0.06）。使用酮咯酸与吻合口漏的显著增加相关（OR为2.09，95%CI为1.12 - 3.89，p = 0.021）。吻合口漏与NSAIDs累积剂量之间无显著关联。
这些数据表明，结直肠手术后NSAIDs与吻合口漏风险之间可能存在关联。需要进一步研究以更好地阐明这种关系，从而明确对患者的影响。
