Perioperative nonsteroidal anti-inflammatory drugs and the risk for anastomotic leakage in patients undergoing major gastrointestinal surgery: a retrospective cohort study

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for postoperative pain management; however, their safety in patients at risk for anastomotic leakage remains uncertain. This study evaluated the association between perioperative use of NSAIDs and anastomotic leakage after major gastrointestinal surgery. Retrospective cohort study. Chinese People’s Liberation Army General Hospital, Beijing, China. Individuals (n = 18,312) who underwent major gastrointestinal surgery between January 2008 and August 2019. Patients were divided into two groups: NSAIDs (n = 8405); and non-NSAIDs (n = 9907). Propensity score matching (PSM) was used to balance baseline characteristics between the two groups, resulting in 6458 patients per group. Logistic regression and subgroup analysis were employed to evaluate the association between NSAID use and postoperative outcomes, as well as the interaction with other risk factors. PSM analysis revealed that perioperative NSAIDs use was associated with a higher risk for anastomotic leakage (odds ratio 1.95, 95% confidence interval 1.48–2.57; P < 0.001). Multivariate logistic models confirmed this association. After classifying NSAIDs into non-selective cyclooxygenase (COX) inhibitors and selective cyclooxygenase-2 (COX-2) inhibitors, multivariate logistic regression analysis demonstrated that selective COX-2 inhibitors were significantly associated with an elevated risk for leakage, whereas non-selective COX inhibitors exhibited no such association. Perioperative use of selective COX-2 inhibitors, but not non-selective NSAIDs, was associated with an increased risk of anastomotic leakage after major gastrointestinal surgery. Therefore, caution should be exercised when selective COX-2 inhibitors are administered to these patients.