Introduction Ileus is common after elective colorectal surgery and is associated with increased adverse events. The aim of this study was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) when used as postoperative analgesia for expediting gastrointestinal recovery.
Methods A prospective, multi-centre, cohort study was delivered across an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January – April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and oral tolerance (GI-2). The impact of NSAIDs was explored using Cox regression analysis, including the results of a centre-specific enhanced recovery questionnaire. The secondary outcome was safety, including anastomotic leak and acute kidney injury.
Results 4164 patients were included with median age 68 (IQR: 57-75) and 54.9% male sex. A total of 1153 (27.7%) received NSAIDs after surgery. There was no difference between NSAID and no NSAID groups in rates of anastomotic leak (5.4 % versus 4.6%; P=0.653) or acute kidney injury (14.3% versus 13.8%; P=0.817), respectively. The mean time to gastrointestinal recovery was 4.7 and 4.8 days respectively, which was non-significant on multivariable analysis (HR: 1.04, 95% CI: 0.96-1.13; P=0.327).
Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but were used safely in the immediate post-operative period.