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Comment & Response |

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

Timo W. Hakkarainen, MD, MS1; David R. Flum, MD, MPH1
[+] Author Affiliations
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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In Reply We are pleased that our study1 has generated debate and discussion regarding the perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) among patients undergoing gastrointestinal surgery, and we sincerely thank the several teams of physicians and surgeons who have taken the time to respond. First, we would like to reiterate that we do not suggest that our data firmly establish causality between perioperative use of NSAIDs and increased rates of anastomotic leak. We believe that our data are strong enough to warrant increased caution when deciding whether or not to use NSAIDs for patients undergoing emergency colorectal procedures. Nor do we dispute the possible benefits of NSAID use in enhanced recovery protocols for their opioid-sparing potential. It is important to note that our data and conclusions are focused on patients undergoing nonelective colorectal procedures, and thus the authors who defend the use of NSAIDs in recovery protocols may be reading too much into our conclusions and taking them out of context. We agree with all the authors who responded that further studies are warranted and needed to address this question and to analyze the type of drug used, the dosage, and the duration of therapy. In our study,1 we simply urge caution.

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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
Thomas M. Drake, BMedSci; Dmitri Nepogodiev, MBChB; Henry A. Claireaux, BSc(Hons)
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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