Use of perioperative non-steroidal anti-inflammatory drugs increases rates of post-operative wound complications in colorectal surgical patients.

Abstract

Purpose/Background: Non-steroidal Anti-Inflammatory Drugs (NSAIDs) play an important role in multimodal analgesia in the perioperative setting. However, the use of NSAIDs is often avoided due to concerns about impaired wound healing resulting from suppression of the inflammatory response to tissue injury. Additionally, potential adverse effects limit the use of these drugs in older patients, those with renal impairment, gastrointestinal bleeding, or other comorbidities. This study aims to review patterns of perioperative NSAID use in colorectal patients in a single Australian centre, and subsequent post-operative complication rates. Methods/Interventions: A retrospective review was undertaken of medical records and charts of 802 colorectal surgical patients undergoing bowel resection with anastomosis between June 2016 and September 2019. We recorded any NSAID use intraoperatively, or within the first 48 hours post-surgery. The primary outcomes measured were overall complication rates, return to theatre, wound complications, anastomotic leak, bleeding requiring intervention, and ileus requiring intervention. Complication rates were compared using Fisher's exact test, with a two-tailed p < 0.05 considered statistically significant. Results/Outcomes: Out of 802 patients, 358 (44.6%) received perioperative NSAIDs-240 intra-operatively (29.9%), 26 post-operatively (3.2%) and 92 both intra-and post-operatively (11.5%). Age was inversely correlated with NSAID use (p < 0.001). NSAID use associated with a statistically significant increase in wound complications rates requiring reoperation, readmission, negative pressure wound therapy or antibiotics-30/ 358 (8.4%) vs. 21/444 (4.7%), p = 0.041 (Fisher's exact test). Perioperative NSAID used did not result in a statistically significant difference in rates of overall complications, reoperation, anastomotic leak, bleeding requiring intervention, ileus requiring intervention, or death, even after performing multivariate binary logistic regression to control for age. Length of stay was shorter among patients receiving perioperative NSAIDs-9.6 days vs. 11.5 days. Conclusion/Discussion: Perioperative NSAID use within our cohort of patients undergoing bowel resection resulted in a statistically significant increase in post-operative wound complications requiring intervention. No other difference in post-operative complication rates was noted. NSAIDs were typically administered to patients intraoperatively by anaesthetists and were seldom continued in the post-operative setting. Younger patients were significantly more likely to be prescribed NSAIDs than older patients. Length of admission was shorter in patients who received NSAIDs, than those who did not.