Effect of Perioperative Dexamethasone and Different NSAIDs on Anastomotic Leak Risk: A Propensity Score Analysis

Abstract

BackgroundPerioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with risk of anastomotic leak (AL). However, concomitant use of other drugs could infer a bias in risk assessment. Thus, we aimed to interrogate the risk of AL associated with NSAIDs and steroids used perioperatively.MethodsThis study includes a consecutive series of patients having surgery involving an intestinal anastomosis from Jan 2007 to Dec 2009. Data records included demographic, perioperative, and surgical characteristics; AL rates; and use of NSAIDs and steroids. Risk of leak were estimated using unadjusted and multivariable (propensity score)-adjusted logistic regression models and reported as odds ratios (ORs).ResultsA total of 376 patients underwent 428 operations of which 67 (15.7 %) had AL. With no medication receivers as reference, the OR for leak when adjusted for age, sex, and propensity score was 1.07 (p = 0.92) for ketorolac, 1.63 (p = 0.31) for diclofenac and 0.41 (p = 0.19) for dexamethasone. Risk was increased for malignancy (OR 1.88, p = 0.023), use of a vasopressor (OR 2.52, p = 0.007), blood transfusions (OR 1.93, p = 0.026), and regular use of steroids (OR 7.57, p = 0.009).ConclusionsOther factors than perioperative drugs are crucial for risk of AL. Perioperative dexamethasone was associated with a nonsignificant reduced risk of AL.

Ghrelin and gastrointestinal wound healing. A new perspective for colorectal surgery

“…Some authors recommend that the NSAIDs should be abandoned after primary colonic anastomosis because of the increase of leak rate that has been consistently demonstrated in experimental and clinical studies [35][36][37][38][39][40] . This find is due to an effect on collagen metabolism leading to weakened tissue around the anastomosis and on the risk of thrombosis formation leading to a decrease of anastomotic blood flow and ischemic damage.…”

Modified Colon Leakage Score to Predict Anastomotic Leakage in Patients Who Underwent Left-Sided Colorectal Surgery

“…Another factor that can be speculated upon is the low rate of patients with preoperative steroid use in our cohort. Although there is still some debate on the real impact of steroid use on AL risk and the definition of steroid use is variable, in previous prospective or retrospective studies, its rate in the pretreatment periods in colorectal surgeries ranged from 2.2 to 5.3% [42,43,44,45,46]. In this study, only four patients (0.7%) were classified as using steroids, although a lower rate of steroid use might be the specific characteristic of our patients.…”

Non-steroidal anti-inflammatory drugs in the oncological surgical population: beneficial or harmful? A systematic review of the literature

“…26 Interestingly, NSAIDs were indeed linked to an increased occurrence of sepsis (OR, 1.47; 95% CI, 1.05-2.06; P¼0.03). 26 Likewise Rushfeldt and colleagues 29 found no association between the use of diclofenac and the risk of anastomotic leak. The authors demonstrated that the administration of vasopressor, blood transfusions and the presence of malignancy were independent risk factors.…”

“…The authors demonstrated that the administration of vasopressor, blood transfusions and the presence of malignancy were independent risk factors. 29 In another large cohort study, patients enrolled in the Swedish Colorectal Cancer Registry were not at risk of anastomotic leak after the perioperative administration of NSAIDs for rectal cancer surgery. 28 In agreement with that investigation, Karlsson and colleagues 32 showed no association between the use of NSAIDs and anastomotic leaks after rectal cancer surgery.…”