Postoperative nonsteroidal anti-inflammatory drug (NSAID) use was associated with anastomotic leak after nonelective colorectal surgery in a population-based surgical database.

The painkillers were associated with a 24% elevated risk for anastomotic leak at the surgical junction after adjustment for other factors (P=0.04), Timo W. Hakkarainen, MD, of the University of Washington Medical Center, Seattle, and colleagues reported online in JAMA Surgery.

But the association between anastomotic leaks within 90 days of surgery and NSAIDs — used by 24% of the patients — was only significant in the nonelective colorectal surgery group.

In that group, the odds of a leak were 70% higher with NSAID use (rate 12.3% versus 8.3% without NSAID use, P=0.01).

The study considered only post-operative use of the anti-inflammatory drugs, without information on preexisting use for cardiovascular prevention.

As postoperative use of NSAIDs have risen with availability of IV formulations, there have been concerns raised by small studies that NSAIDs impair anastomotic healing in the GI tract, Hakkarainen and colleagues noted.

“The results of this large statewide cohort study show that, among patients undergoing nonelective colorectal resection, postoperative NSAID administration is associated with a significantly increased risk for anastomotic complications. Given that other analgesic regimens are effective and well tolerated, these data may be enough for some surgeons to alter practice patterns,” the study concluded.

Leak was defined by reoperation, rescue stoma, revision of an anastomosis, or percutaneous drainage of an abscess. Results were controlled for age, sex, procedure type (bariatric or colorectal), operative approach, protective ostomy, comorbid conditions, body mass index, a low serum albumin level, and other postoperative analgesic use.

Risk-adjusted 90-day mortality was similar between groups.

Limitations included lack of data on which NSAID was used, at what dose, or how long.

Further study is needed to determine if there’s a dose effect, what the mechanism might be, if it’s limited to certain formulations, and if overall recovery is affected, the group added.