急诊普通外科手术中围手术期使用非甾体类抗炎药与吻合口失败风险

Perioperative use of nonsteroidal anti-inflammatory drugs and the risk of anastomotic failure in emergency general surgery.

作者信息

Haddad Nadeem N, Bruns Brandon R, Enniss Toby M, Turay David, Sakran Joseph V, Fathalizadeh Alisan, Arnold Kristen, Murry Jason S, Carrick Matthew M, Hernandez Matthew C, Lauerman Margaret H, Choudhry Asad J, Morris David S, Diaz Jose J, Phelan Herb A, Zielinski Martin D

机构信息

From the Mayo Clinic, Department of Surgery, Division of Trauma, Critical Care and General Surgery (N.N.H., M.C.H., M.D.Z., A.J.C.), Rochester, Minnesota; University of Texas Health Science Center at San Antonio, Department of Surgery (N.N.H.), San Antonio, Texas; University of Maryland School of Medicine, Department of Surgery, Division of Acute Care Surgery (B.R.B., M.H.L., J.J.D.), Baltimore, Maryland; University of Utah, Department of Surgery, Division of General Surgery (T.M.E.), Salt Lake City, Utah; Loma Linda University, Department of Surgery, (D.T.), Loma Linda, California; Johns Hopkins University, Department of Surgery, Division of Acute Care Surgery (J.V.S.), Baltimore, Maryland; Einstein Medical Center, Department of Surgery (A.F.), Philadelphia, Pennsylvania; University of Texas Southwestern/Parkland Hospital, Department of Surgery, (K.A., H.A.P.), Dallas, Texas; East Texas Medical Center (J.S.M.), Alto, Texas; Medical Center of Plano (M.M.C.), Plano, Texas; and Intermountain Medical Center (D.S.M.), Murray, Utah.

出版信息

J Trauma Acute Care Surg. 2017 Oct;83(4):657-661. doi: 10.1097/TA.0000000000001583.

DOI:10.1097/TA.0000000000001583

PMID:28930958

Abstract

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used analgesic and anti-inflammatory adjuncts. Nonsteroidal anti-inflammatory drug administration may potentially increase the risk of postoperative gastrointestinal anastomotic failure (AF). We aim to determine if perioperative NSAID utilization influences gastrointestinal AF in emergency general surgery (EGS) patients undergoing gastrointestinal resection and anastomosis.

METHODS

Post hoc analysis of a multi-institutional prospectively collected database was performed. Anastomotic failure was defined as the occurrence of a dehiscence/leak, fistula, or abscess. Patients using NSAIDs were compared with those without. Summary, univariate, and multivariable analyses were performed.

RESULTS

Five hundred thirty-three patients met inclusion criteria with a mean (±SD) age of 60 ± 17.5 years, 53% men. Forty-six percent (n = 244) of the patients were using perioperative NSAIDs. Gastrointestinal AF rate between NSAID and no NSAID was 13.9% versus 10.7% (p = 0.26). No differences existed between groups with respect to perioperative steroid use (16.8% vs. 13.8%; p = 0.34) or mortality (7.39% vs. 6.92%, p = 0.84). Multivariable analysis demonstrated that perioperative corticosteroid (odds ratio, 2.28; 95% confidence interval, 1.04-4.81) use and the presence of a colocolonic or colorectal anastomoses were independently associated with AF. A subset analysis of the NSAIDs cohort demonstrated an increased AF rate in colocolonic or colorectal anastomosis compared with enteroenteric or enterocolonic anastomoses (30.0% vs. 13.0%; p = 0.03).

CONCLUSION

Perioperative NSAID utilization appears to be safe in EGS patients undergoing small-bowel resection and anastomosis. Nonsteroidal anti-inflammatory drug administration should be used cautiously in EGS patients with colon or rectal anastomoses. Future randomized trials should validate the effects of perioperative NSAIDs use on AF.

LEVEL OF EVIDENCE

Therapeutic study, level III.

摘要

背景

非甾体类抗炎药（NSAIDs）是常用的镇痛和抗炎辅助药物。使用非甾体类抗炎药可能会增加术后胃肠道吻合口失败（AF）的风险。我们旨在确定围手术期使用NSAIDs是否会影响接受胃肠道切除和吻合术的急诊普通外科（EGS）患者的胃肠道AF。

方法

对一个多机构前瞻性收集的数据库进行事后分析。吻合口失败定义为出现裂开/渗漏、瘘管或脓肿。将使用NSAIDs的患者与未使用的患者进行比较。进行了汇总分析、单变量分析和多变量分析。

结果

533例患者符合纳入标准，平均（±标准差）年龄为60±17.5岁，男性占53%。46%（n = 244）的患者围手术期使用NSAIDs。使用NSAIDs组与未使用组的胃肠道AF发生率分别为13.9%和10.7%（p = 0.26）。两组在围手术期使用类固醇（16.8%对13.8%；p = 0.34）或死亡率（7.39%对6.92%，p = 0.84）方面没有差异。多变量分析表明，围手术期使用皮质类固醇（比值比，2.28；95%置信区间，1.04 - 4.81）以及存在结肠结肠或结肠直肠吻合与AF独立相关。对NSAIDs队列的亚组分析显示，与小肠小肠或小肠结肠吻合相比，结肠结肠或结肠直肠吻合的AF发生率更高（30.0%对13.0%；p = 0.03）。