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Comment & Response |

Selective vs Nonselective Nonsteroidal Anti-inflammatory Drugs and Anastomotic Leakage After Colorectal Surgery

Thomas M. Drake, BMedSci1; Dmitri Nepogodiev, MBChB1; Henry A. Claireaux, BSc(Hons)1
[+] Author Affiliations
1Student Audit and Research in Surgery (STARSurg) Steering Group, Birmingham, England
JAMA Surg. 2015;150(7):686. doi:10.1001/jamasurg.2015.0806.
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To the Editor We commend Hakkarainen and colleagues1 for their contribution to the ongoing discussion regarding the association of nonsteroidal anti-inflammatory drugs (NSAIDs) and anastomotic leak following gastrointestinal surgery.

A previous meta-analysis found NSAIDs are significantly associated with an increased risk for anastomotic leak.2 To our knowledge, the study by Hakkarainen et al is the first to suggest that this effect is limited to emergency colorectal patients only. These findings are based on a well-conducted analysis of clearly defined groups from a large prospective database. However, the patients in the NSAID group were significantly younger, with fewer comorbidities than the control arm, which makes it difficult to generate reliable effect estimates between treatment groups. Comparison between groups is further hindered by a lack of data on perioperative and postoperative variables known to be associated with anastomotic leak.3 Nonetheless, it would be interesting to perform a case-matched analysis of the data from Hakkarainen et al and use factors associated with anastomotic leakage to generate improved effect estimates.


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March 1, 2015
Timo W. Hakkarainen, MD, MS; Scott R. Steele, MD; Amir Bastaworous, MD, MBA; E. Patchen Dellinger, MD; Ellen Farrokhi, MD, MPH; Farhood Farjah, MD, MPH; Michael Florence, MD; Scott Helton, MD; Marc Horton, MD; Michael Pietro, MD; Thomas K. Varghese, MD; David R. Flum, MD, MPH
1Department of Surgery, University of Washington Medical Center, Seattle
2Department of Surgery, Madigan Army Medical Center, Ft Lewis, Washington
3Department of Surgery, Swedish Medical Center, Seattle, Washington
4Department of General and Vascular Surgery, Providence Medical Center, Everett, Washington
5Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
6Department of Surgery, St Joseph Medical Center, Bellingham, Washington
7Department of Surgery, Harborview Medical Center, Seattle, Washington
JAMA Surg. 2015;150(3):223-228. doi:10.1001/jamasurg.2014.2239.
July 1, 2015
Fady Saleh, MD, MPH; Allan Okrainec, MD, MHPE
1Division of General Surgery, University Health Network, Toronto, Ontario, Canada
JAMA Surg. 2015;150(7):684-685. doi:10.1001/jamasurg.2015.0635.
July 1, 2015
Noel P. Lynch, MCh, MB, Med Sci; Emily Boyle, MD; Eamon G. Kavanagh, MD, FRCSI
1Department of Surgery, University Hospital Limerick, Limerick, Ireland
JAMA Surg. 2015;150(7):685. doi:10.1001/jamasurg.2015.0641.
July 1, 2015
Kevin Doody, BMBS; Margaret Coleman, FFARCSI, MSc, SEM
1Department of Anaesthesia, University Hospital Limerick, Limerick, Ireland
JAMA Surg. 2015;150(7):685-686. doi:10.1001/jamasurg.2015.0644.
July 1, 2015
Timo W. Hakkarainen, MD, MS; David R. Flum, MD, MPH
1Department of Surgery, University of Washington Medical Center, Seattle
JAMA Surg. 2015;150(7):686-687. doi:10.1001/jamasurg.2015.0638.
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