Safety of Nonsteroidal Antiinflammatory Drugs in

Authors: STARSurg Collaborative

Publish Date: 2016/10/20

Volume: 41, Issue: 1, Pages: 47-55

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Abstract

Significant safety concerns remain surrounding the use of nonsteroidal antiinflammatory drugs NSAIDs following gastrointestinal surgery leading to wide variation in their use This study aimed to determine the safety profile of NSAIDs after major gastrointestinal surgeryConsecutive patients undergoing elective or emergency abdominal surgery with a minimum onenight stay during a 3month study period were eligible for inclusion The administration of any NSAID within 3 days following surgery was the main independent variable The primary outcome measure was the 30day postoperative major complication rate as defined by the Clavien–Dindo classification Clavien–Dindo III–V Propensity matching with multivariable logistic regression was used to produce odds ratios OR and 95  confidence intervalsFrom 9264 patients 239  n = 2212 received postoperative NSAIDs The overall major complication rate was 115  n = 1067 Following propensity matching and adjustment use of NSAIDs were not significantly associated with any increase in major complications OR 090 060–134 p = 0560STARSurg received INSPIRE funding from the Academy of Medical Sciences and the Wellcome Trust The Royal College of Surgeons of England provided meeting facilities for a collaborator training day and the Association of Surgeons in Training http//wwwasitorg supported this meeting with an ASiT Regional Event GrantT M Drake D Nepogodiev S J Chapman J C Glasbey C Khatri C Y Kong H A Claireaux M F Bath M Mohan L McNamee M Kelly H Mitchell J E Fitzgerald E M Harrison A Bhangu overall guarantor Statistical analysis T M Drake A Bhangu E M Harrison statistical guarantor Local leads H A Claireaux University of Bristol Bristol I Antoniou Hull York Medical School Hull R Dean Leicester Medical School Leicester N Davies University of East Anglia Norwich S Trecarten I Henderson University of Nottingham Nottingham C Holmes University of Sheffield Sheffield J Wylie R H Shuttleworth Queen’s University Belfast Belfast A Jindal University of Limerick Limerick F Hughes P Gouda National University of Ireland Galway L McNamee Royal College of Surgeons in Ireland Dublin R Fleck Trinity College Dublin M Hanrahan University College Cork Cork P Karunakaran University College Dublin Dublin J H Chen M C Sykes Imperial College London R K Sethi S Suresh King’s College London P Patel M Patel Queen Mary University London R K Varma J Mushtaq St George’s University of London London B Gundogan University College London London W Bolton University of Leeds Leeds M Mohan T Khan University of Liverpool Liverpool J Burke R Morley University of Manchester Manchester N Favero Newcastle University Medical School Newcastle upon Tyne R Adams University of Aberdeen Aberdeen V Thirumal University of Dundee Dundee E D Kennedy University of Edinburgh Edinburgh K K Ong Y H Tan University of Glasgow Glasgow J Gabriel Brighton and Sussex Medical School Brighton A Bakhsh J Y L Low Peninsula Exeter and Plymouth A Yener Southampton Medical School Southampton V Paraoan University of Cambridge Cambridge R Preece T W Tilston Cardiff University Cardiff E Cumber University of Oxford Oxford S Dean Swansea University Swansea T Ross E McCance University of Birmingham Birmingham H Amin Keele University Keele L Satterthwaite University of Warwick Coventry Other collaborators K D Clement R Gratton E D Mills S M Chiu G Hung N M Rafiq J D B Hayes K L Robertson K Dynes Aberdeen Royal Infirmary Aberdeen H C Huang S Assadullah J W Duncumb R D C Moon S X Poo J K Mehta K R Joshi R Callan J M Norris N J Chilvers H Keevil P Jull Addenbrooke’s Hospital Cambridge S Mallick D Elf L Carr Airedale General Hospital Steeton C Player E C Barton A L Martin S G Ratu E J Roberts P N Phan A R Dyal J E Rogers A D Henson Alexandra Hospital Redditch N B Reid D Burke G Culleton S Lynne D Burke Antrim Area Hospital Antrim S Mansoor C Brennan R Blessed C Holloway A Hill T Goldsmith S Mackin Arrowe Park Hospital Wirral S Kim E Woin G Brent J Coffin O Ziff Barnet Hospital Barnet Z Momoh R Debenham M Ahmed Basingstoke and North Hampshire Hospital Basingstoke C S Yong J C Wan H C Copley P Raut F I Chaudhry Bedford Hospital Bedford R H Shuttleworth G Nixon C Dorman R Tan S Kanabar N Canning M Dolaghan N Bell M McMenamin Belfast City Hospital Belfast A Chhabra K Duke L Turner T Patel L S Chew M Mirza S Lunawat B Oremule Blackpool Victoria Hospital Blackpool N Ward M Khan Bolton Royal Hospital Bolton E T Tan D Maclennan R J McGregor EG Chisholm E J Griffin L Bell Borders General Hospital Melrose B A Hughes J Davies H Haq H Ahmed N Ungcharoen C Whacha R Thethi Bradford Royal Infirmary Bradford R M Markham A H Y Lee E Batt N P Bullock C T Francescon J E Davies N M Shafiq Bristol Royal Infirmary Bristol J Zhao S Vivekanantham I Barai J L Y Allen D C Marshall C J McIntyre H C P Wilson A J Ashton C Lek Charing Cross Hospital London N Behar M DavisHall N Seneviratne S Kim L Esteve M Sirakaya S Ali S Pope J S Ahn A CraigMcQuaide Chelsea and Westminster Hospital London W A Gatfield S Leong A M Demetri A L Kerr Cheltenham General Hospital Cheltenham C Rees J Loveday S Liu M Wijesekera D Maru M Attalla N Smith Chester Hospital Chester D Brown P Sritharan A Shah V Charavanamuttu G HeppenstallHarris K Ng T Raghvani N Rajan K Hulley Colchester Hospital Colchester N Moody M Williams A Cotton Conquest Hospital Hastings M Sharifpour K N Lwin M Bright A R Chitnis M Abdelhadi A D Semana County Hospital Stafford F Morgan R Reid J Dickson L Anderson R McMullan J Dickson N Ahern A Asmadi L B Anderson Craigavon Area Hospital Craigavon J Lua Boon Xuan L Crozier S McAleer Daisy Hill Hospital Newry D M Lees A A Adebayo M Das A H Amphlett Derriford Hospital Plymouth A AlRobeye A Valli J Khangura A Winarski A Ali J Khangura Dewsbury Hospital Dewsbury H Woodward C Gouldthrope M Turner K Sasapu Diana Princess of Wales Hospital Grimsby M Tonkins J R L Wild M Robinson J Hardie R Heminway R Narramore N Ramjeeawon A Hibberd Doncaster Royal Infirmary Doncaster F Winslow W Ho B F Chong K Lim S Ho Dumfries and Galloway Royal Infirmary Dumfries J A Crewdson S Singagireson N Kalra F Koumpa H Jhala W C Soon M Karia M G Rasiah D Xylas Ealing Hospital Southall H Gilbert M SundarSingh J Wills Eastbourne District General Hospital Eastbourne J Mushtaq S Akhtar S Patel L Hu C BrathwaiteShirley H Nayee O Amin T Rangan E J H Turner East Surrey Hospital Redhill C McCrann R Shepherd N Patel J PrestSmith E Auyoung A Murtaza A Coates Epsom Hospital Epsom O PrysJones M King S Gaffney C J Dewdney I Nehikhare J Lavery Forth Valley Royal Hospital Larbert J Bassett K Davies K Ahmad A Collins M Acres C Egerton T Khan Furness General Hospital BarrowinFurness K Cheng X Chen N Chan A Sheldon S Khan J Empey E Ingram A Malik M Johnstone Gartnavel General Hospital Glasgow R Goodier J P Shah J E Giles J A Sanders S W McLure S Pal A Rangedara A N Baker C A Asbjoernsen George Eliot Hospital Nuneaton C Girling L Gray L Gauntlett C Joyner S Qureshi S Dean 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Kosasih H Chin L Ashken R J Pearse R A O’Loughlin A Menon K Singh J Norton King’s College Hospital London R Sagar N Jathanna L Rothwell N Watson F Harding P Dube King’s Mill Hospital SuttoninAshfield H Khalid N Punjabi M Sagmeister P Gill S Shahid S HudsonPhillips D George J Ashwood T Lewis Kingston Hospital Kingston upon Thames M Dhar P Sangal I A Rhema D Kotecha R Dean Z Afzal J A Syeed E Prakash P Jalota R Dean Leicester Royal Infirmary Leicester J Herron L Kimani A Delport A Shukla Lincoln County Hospital Lincoln V Agarwal S Parthiban H Thakur W Cymes S Rinkoff Lister Hospital Stevenage J A Turnbull M Hayat S Darr U Khan J Lim A Higgins Manchester Royal Infirmary Manchester G Lakshmipathy B Forte E Canning A Jaitley J Lamont E Toner A Ghaffar M McDowell D Salmon Mater Infirmorum Hospital Belfast P Gouda O O’Carroll A Khan M E Kelly K Clesham C Palmer R Lyons M E Kelly A Bell R Chin R M Waldron M E Kelly Mayo General Hospital Castlebar A Trimble S E Cox U Ashfaq J Campbell R B S Holliday G McCabe Monklands Hospital Airdrie F Morris R Priestland S Dean O K Vernon A Ledsam R Vaughan Morriston Hospital Swansea D Lim Z R Bakewell R K Hughes Musgrove Park Hospital Taunton R M Koshy H R Jackson P Narayan A E Cardwell C L Jubainville T Arif L E Elliott V Gupta T Arif New Cross Hospital Wolverhampton G Bhaskaran K Singh A Odeleye F Ahmed R Shah A Odeleye J Pickard Y N Suleman A Odeleye Newham University Hospital London A S North L F McClymont N Hussain I Ibrahim G S Ng V Wong A E Lim L N Harris T Tharmachandirar D Mittapalli Ninewells Hospital Dundee V Patel M Lakhani Nobles Hospital Isle of Man N Davies H Z Bazeer V Narwani K K Sandhu L R Wingfield S Gentry H Adjei M Bhatti L Braganza Norfolk and Norwich University Hospital Norwich J Barnes S Mistry G Chillarge S Stokes J Cleere S Wadanamby A M Bucko J Meek N Boxall EG Heywood J J Wiltshire C Toh A E Ward B N Shurovi T M Drake Northern General Hospital Sheffield D Horth B Y Patel B Ali T Spencer T Axelson L Kretzmer C Chhina North Manchester General Hospital Manchester C Anandarajah T Fautz C Horst North Middlesex University Hospital NHS Trust Edmonton A A Thevathasan J Q Ng F Hirst North Tyneside General Hospital North Shields C F Brewer A E Logan J W Lockey P R Forrest N Keelty A D Wood L R Springford P Avery T M Schulz T P Bemand L Howells Northwick Park Hospital Harrow H Collier A Khajuria R G Tharakan S Parsons Nottingham City Hospital Nottingham A M Buchan R J McGalliard J D Mason O J Cundy N Li N A Redgrave R P Watson T P Pezas Y F Dennis E Segall M Hameed A S Lynch John Radcliffe and Churchill Hospitals Oxford M Chamberlain F S Peck Y N Neo G Russell M Elseedawy S Lee N L Foster Y H Soo L Puan Perth Royal Infirmary Perth R Dennis H Goradia A Qureshi Peterborough City Hospital Peterborough S Osman T Reeves L Dinsmore M Marsden Q Lu T PittsTucker Portsmouth Hospitals NHS Trust Queen Alexandra Hospital Portsmouth C E Dunn R A Walford E Heathcote R Martin A Pericleous K Brzyska K G Reid M R 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Royal London Hospital London V Elangovan Z Kazmi J Brecher S Sukumar A Mastan A Mortimer J Parker J Boyle Royal Preston Hospital Preston M Elkawafi J Beckett A Mohite A Narain E Mazumdar A Sreh A Hague D Weinberg L Fletcher Royal Shrewsbury Hospital Shrewsbury M Steel H Shufflebotham M Masood Y Sinha H Amin C Jenvey H Kitt R Slade A R Craig C Deall Y Sinha Royal Stoke University Hospital StokeonTrent J Gabriel T Reakes J Chervenkoff E Strange M O’Bryan C Murkin D Joshi E Strange T Bergara S Naqib D Wylam E Strange Royal Sussex County Hospital Brighton S E Scotcher C M Hewitt M T Stoddart A Kerai A J Trist S J Cole C L Knight S Stevens G E Cooper Royal United Hospital Bath R Ingham J Dobson J Wylie A O’Kane J Moradzadeh A Duffy C Henderson S Ashraf C McLaughin Royal Victoria Hospital Belfast T C Hoskins R S Reehal L R Bookless R C McLean E J Stone Royal Victoria Infirmary Newcastle upon Tyne E V Wright H R Abdikadir C Roberts O Spence M Srikantharajah M Patel E M Ruiz J H Matthews E 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Victoria Hospital Kirkcaldy F Bulley N Warren E Brennan P Fergurson R Wilson H Whittingham Victoria Infirmary Glasgow E J Brown R Khanijau K Gandhi S Morris A J Boulton N Chandan A E Barthorpe R Maamari S Sandhu Walsall Manor Hospital Walsall M McCann L Higgs V Balian C Reeder C Diaper V Balian T Sale H Ali V Balian Warrington Hospital Warrington C H Archer A K Clarke J Heskin P C Hurst J D Farmer L D O’Flynn L Doan B A Shuker G D Stott Warwick Hospital Warwick N A Vithanage K A Hoban P N Nesargikar H R Kennedy C M Grossart E S M Tan C S D Roy P Sim K E Leslie Western General Hospital Edinburgh D Sim M H Abul N Cody A Y Tay E Woon S Sng J Mah J Robson Western Infirmary Glasgow E Shakweh V C Wing H Mills M M Li T R Barrow S Balaji H E M Jordan C Phillips H Naveed West Middlesex Hospital Isleworth S Hirani A Tai R Ratnakumaran A Sahathevan A M A Shafi M Seedat R Weaver Whipps Cross Hospital London A Batho R Punj H Selvachandran N Bhatt S Botchey Z Khonat K Brennan Whiston Hospital Prescot K K Ong C J Morrison E Devlin A Linton E Galloway S McGarvie N Ramsay Wishaw General Hospital Wishaw H D McRobbie H Whewell W Dean Wrexham Maelor Hospital Wrexham S Nelaj M Eragat A Mishra T Kane M Zuhair M Wells D Wilkinson N Woodcock York Hospital York E Sun N Aziz M K Abd Ghaffar Ysbyty Gwynedd Bangor

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