Postoperative non‐steroidal anti‐inflammatory drugs and anastomotic leakage after gastrointestinal anastomoses: Systematic review and meta‐analysis

AIM: Non‐steroidal anti‐inflammatory drugs (NSAIDs) are commonly used to control postoperative pain; however, their postoperative use has been associated with anastomotic leakage after gastrointestinal surgery. This systematic review and meta‐analysis aimed to determine the correlation between the use of NSAIDs and anastomotic leakage. METHODS: We conducted a comprehensive electronic literature search up to August 2018 to identify studies comparing anastomotic leakage in patients with and without postoperative NSAID use following gastrointestinal surgery. We then carried out a meta‐analysis using random‐effects models to calculate odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Twenty‐four studies were included in this meta‐analysis, including a total of 31 877 patients. Meta‐analysis showed a significant association between NSAID use and anastomotic leakage (OR 1.73; 95% CI = 1.31‐2.29, P < .0001). Subgroup analyses showed that non‐selective NSAIDs, but not selective cyclooxygenase‐2 inhibitors, were significantly associated with anastomotic leakage. However there was no significant subgroup difference between selective and non‐selective NSAIDs. CONCLUSION: Results of this meta‐analysis indicate that postoperative NSAID use is associated with anastomotic leakage following gastrointestinal surgeries. Caution is warranted when using NSAIDs for postoperative analgesic control in patients with gastrointestinal anastomoses.