Risk of NSAIDs on Anastomotic Leak for Rectal Surgery
Study Details
Study Description
Brief Summary
Conflicting reports of the association between early postoperative non-steroidal anti-inflammatory drugs (NSAIDs) administration and anastomotic leak (AL) after rectal surgery have continued. The definition of AL and the exposure of NSAIDs differ from each other among studies, which may result in the different conclusions.
The aim of this retrospective study was to clarify the effect of NSAIDs on anastomotic leak from new angels.
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Detailed Description
Concerning about the side effects induced by opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) have gained its popularity in ERAS protocols. NSAIDs competitively inhibits the activity of cyclooxygenases (COXs), which are involved in migration of epithelial cell and mucosal restitution, angiogenesis and collagen synthesis during healing. Conflicting reports of the association between early postoperative non-steroidal anti-inflammatory drugs (NSAIDs) administration and anastomotic leak (AL) after rectal surgery have continued.
Notably, the definition of AL and the exposure of NSAIDs (i.e. NSAIDs administration) differ from each other among the studies, which may result in the different conclusions. In concrete terms, the definition of NSAIDs administration timing varies from the first day to the first week after surgery, while the AL was also defined in multiple ways (timing varies from 14 to 90 days postoperatively, or only leaks with operative intervention included). Most previous studies suggested that early and late AL are different entities with different risk factors. These interesting evidences indicate reconsidering the effect of NSAIDs on AL is needed.
Hence, we defined the NSAIDs administration as at least once in the early postoperative period--the day of and the day after surgery (NSAID group), to avoid the inclusion of patients started on NSAIDs secondary to a complication. At the same time, we also classified AL into early AL (confirmed within 6 days) and late AL (over 6 days). Moreover, concerning the higher rate of AL in rectal surgery than colonic surgery and the trend of minimally invasive surgery, we performed the current study, aiming to clarify the association between early postoperative NSAIDs and anastomotic leak in rectal surgery.
Study Design
Outcome Measures
Primary Outcome Measures
- The incidence of postoperative anastomotic leak [within 30 days]
The primary outcome was anastomotic leak within 30 days after surgery. AL was defined as observing clinical signs of leak (such as high fever, abdominal pain, increasing of inflammatory factors in blood, purulent or fecal drainage from the drain, wound or vagina), and was confirmed by digital imaging or reoperation. Early AL was defined as being confirmed within 6 days postoperatively while late AL was defined as being confirmed after 6 days postoperatively
Secondary Outcome Measures
- The incidence of postoperative compolications [within 30 days]
Secondary outcomes include wound infection, anastomotic bleeding and obstruction.
Eligibility Criteria
Criteria
Inclusion Criteria:
- patients aged over 18 years. (2) patients with rectal adenocarcinoma confirmed by pathology. (3) patients underwent non-emergency minimally invasive surgery with a primary anastomosis.
Exclusion Criteria:
- patients with incomplete medical records. (2) patients with distant metastasis before surgery. (3) patients with multiple primary colorectal carcinomas.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Army Medical Center | Chongqing | None Selected | China |
Sponsors and Collaborators
- Third Military Medical University
Investigators
- Study Director: WeiDong Tong, MD, Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 20230804