Impact of non-steroidal anti-inflammatory drugs on the efficiency of enhanced recovery programmes after colorectal surgery: a retrospective study of the GRACE database - 09/06/21
, Justine J. Monseur c, Anne-Françoise H. Donneau c, Karem Slim b, dthe GRACE Collaborative Groupb
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Highlights |
• | Multimodal analgesia is considered a key element of enhanced recovery programmes (ERPs) after colorectal surgery. The impact of NSAIDs in ERPs has been poorly investigated. |
• | This study suggests that NSAIDs improve the adherence to ERP after colorectal surgery, reduce the incidence of postoperative complications, and shorten the hospital stay. |
• | Benefits of NSAID are evidenced despite of the positive effects of the others elements of the ERP. |
• | Consequently with the limitations inherent in the retrospective nature of our study NSAIDs is a key element of ERP. |
Abstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Adherence to protocol, Colorectal surgery, Enhanced recovery programme, Length of stay, Non-steroidal anti-inflammatory drug, Postoperative complications
Plan
Vol 40 - N° 3
Article 100880- juin 2021 Retour au numéro
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