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Master of Public Health

Is the use of non-steroidal anti-inflammatories after bowel anastomosis in trauma safe?

AUTHORS

Clements TW , Van Gent JM , Hatton GE , Estrada M , Agarwal AK , Cotton BA , . The journal of trauma and acute care surgery. 2023 1 19; ().

ABSTRACT

BACKGROUND: With an increasing interest in multimodal and opioid reducing pain strategies, non-steroidal anti-inflammatory drugs (NSAIDS) have become common-place in the care of injured patients. Long-standing concerns of increased anastomotic leak rate with the use of NSAIDS, however, have persisted. We hypothesized that there would be no significant risk associated with NSAID use after bowel anastomosis in trauma patients.

METHODS: All patients presenting to a level 1 trauma center who required intestinal resection and anastomosis from 2011 to 2017 were reviewed. Patients receiving NSAIDS were compared to those managed without NSAIDS. Primary outcome of interest was anastomosis-related complications (anastomotic leak, intraabdominal abscess, anastomotic bleed, fascial dehiscence, fascial dehiscence, and enterocutaneous fistula). Multivariable logistic regression analyses were performed with propensity adjustment for inverse probability of NSAID treatment weights.

RESULTS: 295 patients met inclusion criteria with 192 receiving NSAIDS. Patients receiving NSAIDS had lower abdominal AIS, and ISS scores(p < 0.046). Arrival SBP, DBP, and GCS were higher in the NSAID group (p < 0.013). After propensity weighting, NSAID use was not a major predictor of anastomotic complication (p = 0.39). There was an increased risk of anastomotic leak with perioperative vasopressor exposure (OR = 3.33(95%CI = 1.17-9.05), p < 0.001). Increasing RBC transfusions in the first 24 hours were associated with intra-abdominal complications (OR = 1.02, 95%CI = 1.00-1.04, p = 0.05). NSAID exposure demonstrated a weak association with anastomotic leak (OR = 1.92, 95%CI = 0.97-3.90, p = 0.06).

CONCLUSION: Consistent with previous studies, peri-operative vasopressor exposure and increased number of RBC transfusions are risk factors for anastomotic leaks and intra-abdominal complications, respectively. NSAID use in trauma patients with multiple risk factors may be associated with an increased risk of anastomotic leak and should be used with caution in the setting of other established risk factors.

LEVEL OF EVIDENCE: Level III, Retrospective comparative study without negative criteria.

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