Clements Thomas W, Van Gent Jan-Michael, Hatton Gabrielle E, Estrada Michelle, Agarwal Amit K, Cotton Bryan A
From the Department of Surgery and The Center for Translational Injury Research University of Texas Health Science Center at Houston; Red Duke Trauma Institute, and Mcgovern School of Medicine.
J Trauma Acute Care Surg. 2023 May 1;94(5):678-683. doi: 10.1097/TA.0000000000003872. Epub 2023 Jan 19.
With an increasing interest in multimodal and opioid-reducing pain strategies, nonsteroidal anti-inflammatory drugs (NSAIDs) have become common place in the care of injured patients. Long-standing concerns of increased anastomotic leak (AL) rate with the use of NSAIDs, however, have persisted. We hypothesized that there would be no significant risk associated with NSAID use after bowel anastomosis in trauma patients.
All patients presenting to a level 1 trauma center who required intestinal resection and anastomosis from 2011 to 2017 were reviewed. Patients receiving NSAIDs were compared with those managed without NSAIDs. Primary outcome of interest was anastomosis-related complications (AL, intra-abdominal abscess, anastomotic bleed, fascial dehiscence, fascial dehiscence, and enterocutaneous fistula). Multivariable logistic regression analyses were performed with propensity adjustment for inverse probability of NSAID treatment weights.
A total of 295 patients met the inclusion criteria with 192 receiving NSAIDs. Patients receiving NSAIDs had lower abdominal Abbreviated Injury Scale and Injury Severity Score ( p < 0.046). Arrival systolic blood pressure, diastolic blood pressure, and Glasgow Coma Scale were higher in the NSAID group ( p < 0.013). After propensity weighting, NSAID use was not a major predictor of anastomotic complication ( p = 0.39). There was an increased risk of AL with perioperative vasopressor exposure (odds ratio [OR], 3.33; 95% confidence interval [CI], 1.17-9.05; p < 0.001). Increasing red blood cell transfusions in the first 24 hours were associated with intra-abdominal complications (OR, 1.02; 95% CI, 1.00-1.04; p = 0.05). Nonsteroidal anti-inflammatory drug exposure demonstrated a weak association with AL (OR, 1.92; 95% CI, 0.97-3.90; p = 0.06).
Consistent with previous studies, perioperative vasopressor exposure and increased number of red blood cell transfusions are risk factors for ALs and intra-abdominal complications, respectively. Nonsteroidal anti-inflammatory drug use in trauma patients with multiple risk factors may be associated with an increased risk of AL and should be used with caution in the setting of other established risk factors.
Therapeutic/Care Management; Level III.
随着对多模式和减少阿片类药物的疼痛策略的兴趣日益增加，非甾体类抗炎药（NSAIDs）在受伤患者的护理中已变得很常见。然而，长期以来对使用NSAIDs会增加吻合口漏（AL）发生率的担忧一直存在。我们假设创伤患者肠吻合术后使用NSAIDs不会有显著风险。
回顾了2011年至2017年在一级创伤中心就诊且需要进行肠切除和吻合术的所有患者。将接受NSAIDs治疗的患者与未使用NSAIDs治疗的患者进行比较。主要关注的结局是吻合口相关并发症（AL、腹腔内脓肿、吻合口出血、筋膜裂开、肠皮肤瘘）。采用倾向得分调整进行多变量逻辑回归分析，以调整NSAIDs治疗权重的逆概率。
共有295例患者符合纳入标准，其中192例接受了NSAIDs治疗。接受NSAIDs治疗的患者腹部简明损伤量表评分和损伤严重程度评分较低（p < 0.046）。NSAIDs组患者到达时的收缩压、舒张压和格拉斯哥昏迷量表评分较高（p < 0.013）。经过倾向得分加权后，使用NSAIDs不是吻合口并发症的主要预测因素（p = 0.39）。围手术期使用血管升压药会增加AL的风险（比值比[OR]，3.33；95%置信区间[CI]，1.17 - 9.05；p < 0.001）。术后24小时内红细胞输注量增加与腹腔内并发症相关（OR，1.02；95% CI，1.00 - 1.04；p = 0.05）。NSAIDs暴露与AL呈弱关联（OR，1.92；95% CI，0.97 - 3.90；p = 0.06）。
与先前的研究一致，围手术期使用血管升压药和红细胞输注量增加分别是AL和腹腔内并发症的危险因素。在有多种危险因素的创伤患者中使用NSAIDs可能会增加AL的风险，在存在其他已确定的危险因素的情况下应谨慎使用。
治疗/护理管理；三级。
