Hakkarainen Timo W, Steele Scott R, Bastaworous Amir, Dellinger E Patchen, Farrokhi Ellen, Farjah Farhood, Florence Michael, Helton Scott, Horton Marc, Pietro Michael, Varghese Thomas K, Flum David R
Department of Surgery, University of Washington Medical Center, Seattle.
Department of Surgery, Madigan Army Medical Center, Ft Lewis, Washington.
JAMA Surg. 2015 Mar 1;150(3):223-8. doi: 10.1001/jamasurg.2014.2239.
Nonsteroidal anti-inflammatory drugs (NSAIDs) have many physiologic effects and are being used more commonly to treat postoperative pain, but recent small studies have suggested that NSAIDs may impair anastomotic healing in the gastrointestinal tract.
To evaluate the relationship between postoperative NSAID administration and anastomotic complications.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 13,082 patients undergoing bariatric or colorectal surgery at 47 hospitals in Washington State from January 1, 2006, through December 31, 2010, using data from the Surgical Care and Outcomes Assessment Program linked to the Washington State Comprehensive Abstract Reporting System.
NSAID administration beginning within 24 hours after surgery.
We used multivariate logistic regression modeling to assess the risk for anastomotic complications (reoperation, rescue stoma, revision of an anastomosis, and percutaneous drainage of an abscess) through 90 days after bariatric and colorectal surgery involving anastomoses.
Of the 13,082 patients (mean [SD] age, 58.1 [15.8] years; 60.7% women), 3158 (24.1%) received NSAIDs. The overall 90-day rate of anastomotic leaks was 4.3% for all patients (151 patients [4.8%] in the NSAID group and 417 patients [4.2%] in the non-NSAID group; P=.16). After risk adjustment, NSAIDs were associated with a 24% increased risk for anastomotic leak (odds ratio, 1.24 [95% CI, 1.01-1.56]; P=.04). This association was isolated to nonelective colorectal surgery, for which the leak rate was 12.3% in the NSAID group and 8.3% in the non-NSAID group (odds ratio, 1.70 [95% CI, 1.11-2.68]; P=.01).
Postoperative NSAIDs were associated with a significantly increased risk for anastomotic complications among patients undergoing nonelective colorectal resection. To determine the role of NSAIDs in colorectal surgery, future evaluations should consider specific formulations, the dose effect, mechanism, and other relevant outcome domains, including pain control, cardiac complications, and overall recovery.
非甾体抗炎药（NSAIDs）具有多种生理效应，目前更常用于治疗术后疼痛，但近期的小型研究表明，NSAIDs可能会损害胃肠道吻合口愈合。
评估术后使用NSAIDs与吻合口并发症之间的关系。
设计、地点和参与者：对2006年1月1日至2010年12月31日期间在华盛顿州47家医院接受减肥手术或结直肠手术的13082例患者进行回顾性队列研究，使用与华盛顿州综合摘要报告系统相关的外科护理和结果评估计划的数据。
术后24小时内开始使用NSAIDs。
我们使用多因素逻辑回归模型评估减肥手术和涉及吻合口的结直肠手术后90天内发生吻合口并发症（再次手术、挽救性造口、吻合口修复和脓肿经皮引流）的风险。
在13082例患者（平均[标准差]年龄，58.1[15.8]岁；60.7%为女性）中，3158例（24.1%）接受了NSAIDs治疗。所有患者的总体90天吻合口漏发生率为4.3%（NSAIDs组151例患者[4.8%]，非NSAIDs组417例患者[4.2%]；P=0.16）。经过风险调整后，NSAIDs与吻合口漏风险增加24%相关（比值比，1.24[95%CI，1.01-1.56]；P=0.0
