Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery
- 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 A.; Litvin A.; Cuk V.V.; Meszarosova K.; Van Straten S.; Jaich R.; De Lima H.; Brooks S.; Marx M.; Nshalati Salvation M.; Clerc D.; Blaser B.; Piazza G.; Gagliardi B.; Serin H.; Yagiz Sen A.; Yurdaor S.S.; Aktas M.K.; Arslan E.; Kopac O.; Uyanik A.; Ozmen B.B.; Tiftik E.; Aksoy B.; Yalcinkaya A.; Ozoglu F.; Kocer M.D.; Bilicen G.; Cinar E.N.; Uslu O.;
- Anno di pubblicazione: 2020
- Tipologia: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/401228
Abstract
Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57-75) years (54 center dot 9 per cent men). Some 1153 (27 center dot 7 per cent) received NSAIDs on postoperative days 1-3, of whom 1061 (92 center dot 0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4 center dot 6 versus 4 center dot 8 days; hazard ratio 1 center dot 04, 95 per cent c.i. 0 center dot 96 to 1 center dot 12; P = 0 center dot 360). There were no significant differences in anastomotic leak rate (5 center dot 4 versus 4 center dot 6 per cent; P = 0 center dot 349) or acute kidney injury (14 center dot 3 versus 13 center dot 8 per cent; P = 0 center dot 666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35 center dot 3 versus 56 center dot 7 per cent; P < 0 center dot 001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.