Impact of non-steroidal anti-inflammatory drugs on the efficiency of enhanced recovery programmes after colorectal surgery: a retrospective study of the GRACE database.
Brolet, Etienne A; Joris, Jean L; Monseur, Justineet al.
2021 • In Anaesthesia, Critical Care and Pain Medicine, 40 (3), p. 100880
Adherence to protocol; Colorectal surgery; Enhanced recovery programme; Length of stay; Non-steroidal anti-inflammatory drug; Postoperative complications; Anti-Inflammatory Agents, Non-Steroidal; Pharmaceutical Preparations; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use; Elective Surgical Procedures; Humans; Length of Stay; Postoperative Complications/epidemiology; Postoperative Complications/prevention & control; Retrospective Studies; Colorectal Surgery; Critical Care and Intensive Care Medicine; Anesthesiology and Pain Medicine; General Medicine
Abstract :
[en] [en] BACKGROUND: Multimodal analgesia is considered a key element of enhanced recovery programmes (ERPs) after colorectal surgery. We investigated the effects of NSAIDs, a major component of multimodal analgesia on adherence to ERP, incidence of postoperative complications, and length of hospital stay (LOS).
METHODS: This was a retrospective study of the GRACE database that included 8611 patients scheduled for colorectal surgery with an ERP between February 2016 and November 2019. Primary endpoints were adherence to the postoperative protocol, the rate and type of postoperative complications, and LOS. Data are median [IQR] and number (per cent). Multivariate models were used to assess the effects of NSAIDs on these variables taking into account potential confounding factors.
RESULTS: Data from 8258 patients were analysed and classified into four groups according to whether NSAIDs had been given intra- and/or postoperatively or not at all; 4578 patients were given NSAIDs intra- and/or postoperatively and 3680 patients received no NSAIDs. Use of NSAIDs was significantly (P<0.001) associated with improved adherence to the postoperative protocol (4.0 [3.0-4.0] vs. 3.0 [2.0-4.0] items), a reduced incidence of complications (21.1% vs. 29.2%), and a shortened LOS (5.0 [3.0-7.0] vs. 6.0 [4.0-9.0] days) compared to the no-NSAIDs group. Multivariate analyses adjusted for the confounding factors confirmed a significant (P<0.001) beneficial impact of NSAIDs on these three primary endpoints.
CONCLUSION: This study suggests that perioperative NSAID use results in better adherence to the postoperative protocol, fewer postoperative in-hospital complications, and shorter LOS after colorectal surgery.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Brolet, Etienne A; Department of Anaesthesia and Intensive Care Medicine, CHU Liège, University of Liège, Liège, Belgium
Joris, Jean L ; CHU Liège, University of Liège, Liège, Belgium > Department of Anaesthesia and Intensive Care Medicine ; Groupe Francophone de Réhabilitation Améliorée Après Chirurgie (GRACE, Francophone Group for Enhanced Recovery After Surgery, www.grace-asso.fr), Beaumont, France
Monseur, Justine ; Université de Liège - ULiège > Département des sciences de la santé publique > Biostatistique
Donneau, Anne-Françoise ; Université de Liège - ULiège > Département des sciences de la santé publique
Slim, Karem; CHU Estaing, 63003 Clermont-Ferrand, France > Service of Digestive Surgery and Unit of Ambulatory Surgery, ; Groupe Francophone de Réhabilitation Améliorée Après Chirurgie (GRACE, Francophone Group for Enhanced Recovery After Surgery, www.grace-asso.fr), Beaumont, France
GRACE Collaborative Group; Groupe Francophone de Réhabilitation Améliorée Après Chirurgie (GRACE, Francophone Group for Enhanced Recovery After Surgery, www.grace-asso.fr), Beaumont, France
Language :
English
Title :
Impact of non-steroidal anti-inflammatory drugs on the efficiency of enhanced recovery programmes after colorectal surgery: a retrospective study of the GRACE database.
This study received financial support from GRACE (Francophone group for enhanced recovery after surgery, Beaumont, France, www.grace-aaso.fr ). The funding source had no involvement in study design, collection, analysis or interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
Ljungqvist, O., Scott, M., Fearon, K.C., Enhanced recovery after surgery: a review. JAMA Surg 152:3 (2017), 292–298.
Kehlet, H., Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:5 (1997), 606–617.
Scott, M.J., Baldini, G., Fearon, K.C., Feldheiser, A., Feldman, L.S., Gan, T.J., et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiol Scand 59:10 (2015), 1212–1231.
Greco, M., Capretti, G., Beretta, L., Gemma, M., Pecorelli, N., Braga, M., Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38:6 (2014), 1531–1541.
Nicholson, A., Lowe, M.C., Parker, J., Lewis, S.R., Alderson, P., Smith, A.F., Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101:3 (2014), 172–188.
Grant, M.C., Yang, D., Wu, C.L., Makary, M.A., Wick, E.C., Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: results from a systematic review and meta-analysis. Ann Surg 265:1 (2017), 68–79.
Gustafsson, U.O., Scott, M.J., Hubner, M., Nygren, J., Demartines, N., Francis, N., et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. World J Surg 43:3 (2019), 659–695.
Alfonsi, P., Slim, K., Chauvin, M., Mariani, P., Faucheron, J.L., Fletcher, D., French guidelines for enhanced recovery after elective colorectal surgery. J Visc Surg 151:1 (2014), 65–79.
Ripolles-Melchor, J., Ramirez-Rodriguez, J.M., Casans-Frances, R., Aldecoa, C., Abad-Motos, A., Logrono-Egea, M., et al. Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: the postoperative outcomes within enhanced recovery after surgery protocol (POWER) study. JAMA Surg 154:8 (2019), 725–736.
Jurt, J., Slieker, J., Frauche, P., Addor, V., Sola, J., Demartines, N., et al. Enhanced recovery after surgery: can we rely on the key factors or do we need the bel ensemble?. World J Surg 41:10 (2017), 2464–2470.
Slim, K., Joris, J., The egg-and-chicken situation in postoperative enhanced recovery programmes. Br J Anaesth 118:1 (2017), 5–6.
Aarts, M.A., Rotstein, O.D., Pearsall, E.A., Victor, J.C., Okrainec, A., McKenzie, M., et al. Postoperative ERAS interventions have the greatest impact on optimal recovery: experience with implementation of ERAS across multiple hospitals. Ann Surg 267:6 (2018), 992–997.
Joshi, G.P., Kehlet, H., Postoperative pain management in the era of ERAS: an overview. Best Pract Res Clin Anaesthesiol 33:3 (2019), 259–267.
Marret, E., Kurdi, O., Zufferey, P., Bonnet, F., Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology 102:6 (2005), 1249–1260.
Barletta, J.F., Asgeirsson, T., Senagore, A.J., Influence of intravenous opioid dose on postoperative ileus. Ann Pharmacother 45:7-8 (2011), 916–923.
Kehlet, H., Rung, G.W., Callesen, T., Postoperative opioid analgesia: time for a reconsideration?. J Clin Anesth 8:6 (1996), 441–445.
Martinez, V., Beloeil, H., Marret, E., Fletcher, D., Ravaud, P., Trinquart, L., Non-opioid analgesics in adults after major surgery: systematic review with network meta-analysis of randomized trials. Br J Anaesth 118:1 (2017), 22–31.
Chapman, S.J., Garner, J.J., Drake, T.M., Aldaffaa, M., Jayne, D.G., Systematic review and meta-analysis of nonsteroidal anti-inflammatory drugs to improve GI recovery after colorectal surgery. Dis Colon Rectum 62:2 (2019), 248–256.
Milne, T.G.E., Jaung, R., O'Grady, G., Bissett, I.P., Nonsteroidal anti-inflammatory drugs reduce the time to recovery of gut function after elective colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 20:8 (2018), O190–8.
Chang, R.W., Tompkins, D.M., Cohn, S.M., Are NSAIDs safe? Assessing the risk-benefit profile of nonsteroidal anti-inflammatory drug use in postoperative pain management. Am Surg, 2020, 10.1177/0003134820952834.
Klein, M., Gogenur, I., Rosenberg, J., Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data. B Med J, 345, 2012, e6166.
Jans, O., Kehlet, H., Postoperative orthostatic intolerance: a common perioperative problem with few available solutions. Can J Anaesth 64:1 (2017), 10–15.
Nelson, G., Kiyang, L.N., Crumley, E.T., Chuck, A., Nguyen, T., Faris, P., et al. Implementation of enhanced recovery after surgery (ERAS) across a provincial healthcare system: the ERAS Alberta colorectal surgery experience. World J Surg 40:5 (2016), 1092–1103.
Clavien, P.A., Barkun, J., de Oliveira, M.L., Vauthey, J.N., Dindo, D., Schulick, R.D., et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:2 (2009), 187–196.
Holte, K., Kehlet, H., Postoperative ileus: a preventable event. Br J Surg 87:11 (2000), 1480–1493.
EuroSurg Colaborative, Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery. Br J Surg 107:2 (2020), e161–9.
Hawkins, A.T., McEvoy, M.D., Wanderer, J.P., Ford, M.M., Hopkins, M.B., Muldoon, R.L., et al. Ketorolac use and anastomotic leak in elective colorectal surgery: a detailed analysis. Dis Colon Rectum 61:12 (2018), 1426–1434.
Arron, M.N.N., Lier, E.J., de Wilt, J.H.V., Stommel, M.W.J., van Goor, H., ten Broeck, R.P.G., Postoperative administration of non-steroidal anti-inflammatory drugs in colorectal cancer surgery does not increase anastomotic leak rate: a systematic review and meta-analysis. Eur J Surg Oncol 46 (2020), 2167–2173.
Grant, M.C., Pio Roda, C.M., Canner, J.K., Sommer, P., Galante, D., Hobson, D., et al. The Impact of anesthesia-influenced process measure compliance on length of stay: results from an enhanced recovery after surgery for colorectal surgery cohort. Anesth Analg 128:1 (2019), 68–74.
Cortez, A.R., Kassam, A.F., Levinsky, N.C., Jung, A.D., Daly, M.C., Shah, S.A., et al. Enhanced recovery protocol improves postoperative outcomes and minimizes narcotic use following resection for colon and rectal cancer. Surg Open Sci 1 (2019), 74–79.
