Postoperative Nonsteroidal Anti-inflammatory Drugs and Risk of Anastomotic Leak: Meta-analysis of Clinical and Experimental Studies

@article{Bhangu2014PostoperativeNA,
  title={Postoperative Nonsteroidal Anti-inflammatory Drugs and Risk of Anastomotic Leak: Meta-analysis of Clinical and Experimental Studies},
  author={Aneel Bhangu and Prashant Singh and James Edward Frankland Fitzgerald and Alistair Slesser and Paris P. Tekkis},
  journal={World Journal of Surgery},
  year={2014},
  volume={38},
  pages={2247-2257}
}
AbstractBackground Enhanced recovery programs following colorectal resection recommend the use of nonsteroidal anti-inflammatory drugs (NSAIDs) as part of multimodal analgesia. The present study aimed to assess whether postoperative NSAID use increased the risk of anastomotic leak. Methods A systematic review of published literature was performed for studies comparing anastomotic leak following NSAID administration versus control. Meta-analysis was conducted for studies in human patients and… 
Risk of anastomotic leakage with nonsteroidal anti-inflammatory drugs within an enhanced recovery program
TLDR
The results of this study are in line with other comparable studies in the literature, showing an increased risk for anastomotic leakage with diclofenac, and the use ofdicl ofenac in colorectal surgery can no longer be recommended.
Nonsteroidal Anti-inflammatory Drugs: Do They Increase the Risk of Anastomotic Leaks Following Colorectal Operations?
TLDR
No statistically significant increase in the proportion of patients with anastomotic leak was observed when prescribing nonsteroidal anti-inflammatory drugs for analgesia in the early postoperative period for patients undergoing elective colorectal surgery, but there was an increased risk of sepsis that warrants further investigation.
Perioperative use of nonsteroidal anti-inflammatory drugs and the risk of anastomotic failure in emergency general surgery.
TLDR
Perioperative NSAID utilization appears to be safe in EGS patients undergoing small-bowel resection and anastomosis, and nonsteroidal anti-inflammatory drug administration should be used cautiously in E GS patients with colon or rectal anastsomoses.
Nonsteroidal anti-inflammatory drugs and the risk of anastomotic leakage after anterior resection for rectal cancer.
NSAID administration post colorectal surgery increases anastomotic leak rate: systematic review/meta-analysis
TLDR
Great caution must be taken when prescribing NSAIDs following colonic or rectal anastomotic creation, as the safety profile varies within the NSAID class and further research is needed to clarify which NSAIDs are safe for use and which are not.
Effect of Perioperative Dexamethasone and Different NSAIDs on Anastomotic Leak Risk: A Propensity Score Analysis
TLDR
Perioperative dexamethasone was associated with a nonsignificant reduced risk of anastomotic leak and other factors than perioperative drugs are crucial for risk of AL.
Postoperative Nonsteroidal Anti-inflammatory Drug Use and Intestinal Anastomotic Dehiscence: A Systematic Review and Meta-Analysis
TLDR
Pooled observational data suggest an association between postoperative nonsteroidal anti-inflammatory drug use and intestinal anastomotic dehiscence, and caution may be warranted in using these medications in patients at risk for this complication.
Should colorectal surgeons continue to use nonsteroidal anti‐inflammatory drugs?
TLDR
There is mounting concern regarding the propensity of NSAIDs to cause anastomotic leaks and septic complications after colorectal surgery, and the clinical benefits are probably relatively minor.
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References

SHOWING 1-10 OF 46 REFERENCES
Nonsteroidal Anti-inflammatory Drugs and Anastomotic Dehiscence in Bowel Surgery: Systematic Review and Meta-Analysis of Randomized, Controlled Trials
TLDR
A statistically significant difference in incidence of anastomotic dehiscence was not demonstrated in randomized, controlled trials of perioperative nonsteroidal anti-inflammatory drugs, and lack of heterogeneity between trials suggest that this finding may be due to a lack of power of the available data rather than a loss of effect.
Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data
TLDR
Diclofenac treatment could result in an increased proportion of patients with anastomotic leakage after colorectal surgery, and Cyclo-oxygenase-2 selective NSAIDs should be used with caution after colOREctal resections with primary anastsomosis.
The effects of non-steroid anti-inflammatory drugs on healing of colonic anastomosis in rats
TLDR
Because tenoxicam promoted fibrosis, and metamizole increased collagen synthesis, with both agents showing few disadvantages, these 2 agents are recommended above diclofenac for promoting healing.
Identifying Important Predictors for Anastomotic Leak After Colon and Rectal Resection: Prospective Study on 616 Patients
TLDR
In multivariate analysis, significant independent predictors for leak were anastomoses less than 10 cm from the anal verge, CCI of 3 or more, high inferior mesenteric artery ligation, intraoperative complications, and being of the male sex.
Effect of Diclofenac on Cyclooxygenase-2 Levels and Early Breaking Strength of Experimental Colonic Anastomoses and Skin Incisions
TLDR
This study for the first time showed that a diclofenac dose of 4 mg/kg/24 h was sufficient to reduce the level of COX-2 enzymes in the anastomotic tissue in rats, and inhibition of the inflammatory response did not lead to reduced breaking strength of either anastsomotic or incisional wounds.
Diclofenac causes more leakage than naproxen in anastomoses in the small intestine of the rat
TLDR
This study implies that immediate postoperative administration of diclofenac and, to a far lesser extent, naproxen can affect healing in the ileal anastomosis in the rat.
Risk Factors and Outcomes for Anastomotic Leakage in Colorectal Surgery: A Single-Institution Analysis of 1576 Patients
TLDR
Advanced tumour stage, distal site, and need for postoperative blood transfusion were associated with increased rates of anastomotic leakage, and both localized and generalized leaks had similarly negative impacts on overall, cancer-related, and disease-free survival.
Effect of Postoperative Diclofenac on Anastomotic Healing, Skin Wounds and Subcutaneous Collagen Accumulation: A Randomized, Blinded, Placebo-Controlled, Experimental Study
TLDR
Postoperative diclofenac treatment significantly inhibited collagen deposition in subcutaneous granulation tissue and the ePTFE model is suitable for assessing the effect of various drugs on collagen formation and thus on wound healing.
Peptic ulcer and bleeding events associated with rofecoxib in a 3-year colorectal adenoma chemoprevention trial.
TLDR
Among patients with a history of colorectal adenomas, the long-term use of 25 mg/day of rofecoxib was associated with an increased risk of clinically relevant upper gastrointestinal events when compared with placebo.
The influence of NSAIDs on experimental intestinal anastomoses
TLDR
It is concluded that nonsteroidal anti-inflammatory drugs may limit postoperative degradation of collagen in colonic anastomoses, but at the same time may increase the rat's susceptibility to surgical infections.
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