Tony Milne is a junior registrar with a keen interest in academic surgery. He is currently working towards completing a PhD at the University of Auckland, looking at predicting and preventing postoperative ileus after elective colorectal surgery.
Non-Steroidal Anti-Inflammatory Drugs Improve Recovery of Gut Function after Elective Colorectal Surgery: A Systematic Review and Meta-Analysis
Aims: Postoperative ileus causes significant patient morbidity after abdominal surgery. Some evidence suggests non-steroidal anti-inflammatory drugs (NSAIDs) may reduce time to gut recovery, but there has not been a meta-analysis to assess their efficacy. The aim of this study was to determine the benefit of NSAID use in patients undergoing major abdominal surgery on recovery of post-operative gut function by systematic review and meta-analysis.
Methods: MEDLINE, EMBASE, CENTRAL and reference lists were searched by two independent reviewers, with no date or language restrictions. Randomised controlled trials comparing the use of NSAIDs to placebo in the perioperative or postoperative period were identified. Included studies reported outcomes relevant to gut function after major abdominal surgery: time to pass flatus or stool and time to tolerate an oral diet. Selective and non-selective NSAIDs were included. The mean difference in time from surgery until passage of flatus, stool and tolerance of diet were meta-analysed using a random-effects model in RevMan 5.3.
Results: This study identified 992 relevant articles. Ten randomised controlled trials, met our inclusion criteria. Five trials on patients undergoing elective colorectal surgery were meta-analysed, which included 515 patients (294 NSAID vs. 221 placebo). Compared to placebo, NSAIDs significantly improved the time to pass flatus (mean difference -9.44 hours, 95% CI: -17.22, -1.65, I2=70%, p=0.02), time to pass stool (mean difference -12.09 hours, 95% CI: -17.16, -7.02, I2=0%, p<0.001) and time to tolerate a diet (mean difference -11.95 hours, 95% CI: -18.66, -5.24, I2=0%, p<0.001). Only two studies compared the use of selective NSAIDs to placebo, which prevented subgroup analysis.
Conclusions: NSAIDs significantly improve time to gut recovery after elective colorectal surgery. Present evidence is not adequate to identify whether selective or non-selective drugs should be recommended. Further high-power studies using selective NSAIDs are required.