Chen Wen, Liu Jing, Yang Yongqiang, Ai Yanhong, Yang Yueting
Department of Anus and Intestine Surgery, Shijiazhuang People Hospital, Shijiazhuang, China.
Department of Endocrinology, Hebei General Hospital, Shijiazhuang, China.
Front Surg. 2022 Feb 9;9:652806. doi: 10.3389/fsurg.2022.652806. eCollection 2022.
This meta-analysis aimed to evaluate whether ketorolac administration is associated with an increased anastomotic leak rate after colorectal surgery.
The literature was searched using the Web of Science, Embase, and PubMed databases, and the search ended on May 31, 2020. The Newcastle-Ottawa Scale was used to assess methodological quality. Statistical heterogeneity was assessed using the Chi-square test and statistics. Subgroup analysis was performed, and Egger's test was used to assess publication bias.
This meta-analysis included seven studies with 400,822 patients. Our results demonstrated that ketorolac administration after surgery increases the risk of anastomotic leak [OR = 1.41, 95% CI: 0.81-2.49, = 1.21, = 0.23]. Low heterogeneity was observed across these studies ( = 0%, = 0.51). The results of subgroup analysis showed that the use of ketorolac in case-control and retrospective cohort studies significantly increased the risk of anastomotic leak ( < 0.05). Furthermore, the subgroup analysis revealed that ketorolac use increased anastomotic leak rate in patients in the United States and Canada, and ketorolac plus morphine use did not increase anastomotic leak rate in Taiwanese patients ( < 0.05). No significant publication bias was observed ( = 0.126). Moreover, the analysis of risk factors related to anastomotic leak rate indicated that the total use of ketorolac did not increase the risk of anastomotic leak similar to the control group ( > 0.05).
The meta-analysis indicates that the use of ketorolac increases the risk of anastomotic leak after colorectal surgery.
PROSPERO, identifier CRD42020195724.
本荟萃分析旨在评估结直肠手术后使用酮咯酸是否会增加吻合口漏发生率。
通过科学网、Embase和PubMed数据库检索文献，检索截至2020年5月31日。采用纽卡斯尔-渥太华量表评估方法学质量。使用卡方检验和I²统计量评估统计异质性。进行亚组分析，并使用Egger检验评估发表偏倚。
本荟萃分析纳入了7项研究，共400822例患者。我们的结果表明，术后使用酮咯酸会增加吻合口漏的风险[比值比（OR）=1.41，95%置信区间（CI）：0.81 - 2.49，I² = 1.21，P = 0.23]。这些研究中观察到低异质性（I² = 0%，P = 0.51）。亚组分析结果显示，在病例对照研究和回顾性队列研究中使用酮咯酸显著增加了吻合口漏的风险（P < 0.05）。此外，亚组分析显示，在美国和加拿大患者中使用酮咯酸会增加吻合口漏发生率，而在台湾患者中使用酮咯酸加吗啡并未增加吻合口漏发生率（P < 0.05）。未观察到显著的发表偏倚（P = 0.126）。此外，与吻合口漏发生率相关的危险因素分析表明，与对照组相比，酮咯酸的总体使用并未增加吻合口漏的风险（P > 0.05）。
该荟萃分析表明，结直肠手术后使用酮咯酸会增加吻合口漏的风险。
国际前瞻性系统评价注册库（PROSPERO），标识符CRD42020195724 。
