Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery
Articolo
Data di Pubblicazione:
2019
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.
Tipologia CRIS:
14.a.1 Articolo su rivista
Elenco autori:
Chapman, S. J.; Clerc, D.; Blanco-Colino, R.; Otto, A.; Nepogodiev, D.; Pagano, G.; Schaeff, V.; Soares, A.; Zaffaroni, G.; Zebrak, R.; Hodson, J.; Blanco-Colino, R.; Chapman, S. J.; Glasbey, J. C.; Pata, P.; Pellino, G.; Sgro, A.; Soares, A.; van Elst, T.; Van Straten, S.; Knowles, C. H.; Nepogodiev, D.; Hodson, J.; Borakati, A.; Bath, M. F.; Yasin, I. H.; Mclean, K.; Arthur, T.; Kovacevic, M.; Delibegovic, S.; Karamanliev, M.; Swamad, M.; Zebrak, R.; Paramasivam, R.; Martensen, A.; Larsen, H. M.; Radeker, L.; Frey, P. E.; Kechagias, A.; Venara, A.; Duchalais, E.; Ioannidis, A.; Pata, F.; Pellino, G.; Pasquali, S.; Sgro, A.; Simioni, A.; Farina, V.; Podda, M.; Lorenzon, L.; Schaeff, V.; Otto, A.; Jakubauskas, M.; van Elst, T. R.; Chu, M.; Fagan, P. V. B.; Wells, C. I.; Alagoa Joao, A.; Soares, A.; Juloski, J.; Clerc, D.; Ciubotaru, C.; Popescu, S.; Yanishev, A.; Lee, S.; Ozkan, B. B.; Yagiz Sen, A.; Aktas, M. K.; Baki, B. E.; Yuksek, B.; Glasbey, J. C.; Kamarajah, S.; Mclean, K.; Borakati, A.; Yasin, I. H.; Khaw, R. A.; Mills, E.; Goodson, R.; Thakral, N.; Ablett, A. D.; Adra, M.; Kwek, I.; Khan, S. M.; Quinn, P.; Manley, L. R.; Badran, A.; Ramjeeawon, A.; Campbell, A.; Tan, H. L.; Rye, D. S.; Rajaraman, N.; Norman, J. G.; Vutipongsatorn, K.; Solomou, G.; Akhbari, M.; Ali, A.; Murray, V.; Baker, D. M.; Brandao, B. D.; Stainer, B.; Thavayogan, R.; Jones, D.; Onafowokan, O. O.; Gharooni, A.; Dabab, N.; Carlton-Carew, S.; Kungwengwe, G.; Gabriel, M.; Sewart, E.; Shortland, T. C.; Lawday, S.; Pockney, P.; Dawson, A.; Arthur, T.; Brumfitt, C. D.; Stewart, P.; Ng, B.; Luong, J. K.; Delibegovic, S.; Ivanov, V.; Borisova, A.; Neykov, V.; Kuncarova, K.; Kolosova, B.; Antonova, T.; Farkasova, M.; Zebrak, R.; Harbjerg, J. L.; Brandsborg, S.; Brinck, S.; Kjaer, M. D.; Mark-Christensen, A.; Unbehaun, K. P.; Dalsgaard, P.; Lycke, K. D.; Kechagias, A.; Lenaoures, P.; Duchalais, E.; Brigand, C.; Dumange, E.; Gout, M.; Moehwald, C.; Prem, M.; Alhalabi, O.; Sliwinski, S.; Krupp, J.; Gablenz, E.; Schmitzer, L.; Kopp, A.; Steinle, J.; Gsenger, J.; Pohl, L. J.; Riccardi, M.; Christodoulou, I. M.; Konstantinidis, M.; Machairas, N.; Zoikas, A.; Balalis, D.; Manatakis, D. K.; Aguilera, M. L.; Sgro, A.; Simioni, A.; Marano, L.; Fleres, F.; Lovisetto, F.; Sasia, D.; Segalini, E.; Pata, G.; Lucchi, A.; Sagnotta, A.; Campagnaro, T.; Petrelli, F.; Gallo, G.; Papandrea, M.; Testa, V.; Sinibaldi, G.; Di Candido, F.; Colombo, F.; Perrone, G.; Aresu, S.; Biancafarina, A.; Canonico, G.; Pagnanelli, M.; Curletti, G.; Bini, R.; de Manzoni Garberini, A.; Impellizzeri, H.; Cillara, N.; Tutino, R.; Picciariello, A.; Coletta, D.; Savino, G.; Ferrara, F.; Tamini, N.; Talamo, G.; Parini, D.; Giamundo, P.; lo Conte, A.; Pagano, G.; Ripetti, V.; Pesce, A.; Menduni, N.; Pellino, G.; Giudicissi, R.; Podda, M.; Goldin, E.; Rega, D.; Belli, A.; Andriola, V.; Gordini, L.; Pata, F.; Foppa, C.; Piccolo, G.; Birindelli, A.; Ferrari, C.; Ballarini, Z.; Tirelli, F.; Milone, M.; De Rosa, M.; Pipitone Federico, N. S.; Molteni, B.; Tilocca, P. L.; Sancini, G.; Piozzi, G. N.; Lauretta, A.; Poillucci, G.; Mulas, S.; Schaeff, V.; Otto, A.; Jakubauskas, M.; Simcikas, D.; Portelli, L.; van Wijnbergen, J. W. M.; Dinger, T. L.; ten Doesschate, S. F. H.; van Dalen, A. S. H. M.; van den Bos, D. D.; Hansmann, M.; Medina Feliz, J.; Kuiper, S. Z.; Abdulrahman, Z.; Pruijssers, S. R.; Farik, S.; Elliott, B. M.; Geneta, V. P.; Chu, M.; Wilton, S.; Kandelaki, H.; Peng, S. L.; Campbell, S.; Lim, Y. K.; Yassaie, S. S.; Murray, M.; Fagan, P. V. B.; Haran, C.; Tan, J.; Castro, J.; Laranjeira, A.; Catarino, S.; Neves-Marques, C.; Correia, J. G.; Vieira, B. N.; Quintela, A. C.; Serra, M. L.; Maciel, J.; Cunha, M.; Aparicio, D. J.; Neves, J.; Azevedo, J.; Romano, M.; Eiro, F.; Romano, J.; Monteiro, C.; Claro, M.; Almeida, M. R.; Peyroteo, M.; Machado, N. D.; Capote, H.; Ferreira, M.; Sousa, X.; Devesa, H.; Cavadas, D.; Guerreiro, I.; Costa, M.; Salman, M.; English, C.; Mohammed, N.; Popescu, S.; Yanishev
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