Perioperative Use of Nonsteroidal Anti-Inflammatory Drugs and the Risk of Anastomotic Failure in Emergency General Surgery.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used analgesic and anti-inflammatory adjuncts. NSAID administration may potentially increase the risk of postoperative gastrointestinal anastomotic failure (AF). We aim to determine if perioperative NSAID utilization influences gastrointestinal anastomotic failure 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 utilizing NSAIDS were compared to those without. Summary, univariate and multivariable analyses were performed. Results: 533 patients met inclusion criteria with a mean (+/-SD) age of 60 +/-17.5years, 53% male. There were 46% (n=244) patients utilizing perioperative NSAIDs. Gastrointestinal anastomotic failure (AF) rate between NSAID and no NSAID was (13.9% vs 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 (OR 2.28, CI 1.04-4.81) use and the presence of a colocolonic or colorectal anastomoses were independently associated with anastomotic failure. A subset analysis of the NSAIDs cohort demonstrated an increased AF rate in colocolonic or colorectal anastomosis compared to enteroenteric or enterocolonic anastomoses (30.0% vs 13.0%, p=0.03). Conclusion: Perioperative NSAID utilization appears to be safe in emergency general surgery patients undergoing small bowel resection and anastomosis. NSAIDs 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 (C) 2017 Lippincott Williams & Wilkins, Inc.

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