Background:Ileus is common after elective colorectal surgery, and is associated with increased adverseevents and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatorydrugs (NSAIDs) for reducing ileus after surgery.Methods:A prospective multicentre cohort study was delivered by an international, student- andtrainee-led collaborative group. Adult patients undergoing elective colorectal resection between Januaryand April 2018 were included. The primary outcome was time to gastrointestinal recovery, measuredusing a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs wasexplored using Cox regression analyses, including the results of a centre-specific survey of complianceto enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acutekidney injury.Results:A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54⋅9percent men). Some 1153 (27⋅7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92⋅0per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, themean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDsand those who did not (4⋅6versus4⋅8 days; hazard ratio 1⋅04, 95 per cent c.i. 0⋅96 to 1⋅12;P=0⋅360). Therewere no significant differences in anastomotic leak rate (5⋅4versus4⋅6 per cent;P=0⋅349) or acute kidneyinjury (14⋅3versus13⋅8 per cent;P=0⋅666) between the groups. Significantly fewer patients receivingNSAIDs required strong opioid analgesia (35⋅3versus56⋅7 per cent;P<0⋅001).Conclusion:NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, butthey were safe and associated with reduced postoperative opioid requirement.

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Cucinotta E.;
2019-01-01

Abstract

Background:Ileus is common after elective colorectal surgery, and is associated with increased adverseevents and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatorydrugs (NSAIDs) for reducing ileus after surgery.Methods:A prospective multicentre cohort study was delivered by an international, student- andtrainee-led collaborative group. Adult patients undergoing elective colorectal resection between Januaryand April 2018 were included. The primary outcome was time to gastrointestinal recovery, measuredusing a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs wasexplored using Cox regression analyses, including the results of a centre-specific survey of complianceto enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acutekidney injury.Results:A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54⋅9percent men). Some 1153 (27⋅7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92⋅0per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, themean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDsand those who did not (4⋅6versus4⋅8 days; hazard ratio 1⋅04, 95 per cent c.i. 0⋅96 to 1⋅12;P=0⋅360). Therewere no significant differences in anastomotic leak rate (5⋅4versus4⋅6 per cent;P=0⋅349) or acute kidneyinjury (14⋅3versus13⋅8 per cent;P=0⋅666) between the groups. Significantly fewer patients receivingNSAIDs required strong opioid analgesia (35⋅3versus56⋅7 per cent;P<0⋅001).Conclusion:NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, butthey were safe and associated with reduced postoperative opioid requirement.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11570/3149628
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