Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery.

Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54⋅9 per cent men). Some 1153 (27⋅7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92⋅0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4⋅6 versus 4⋅8 days; hazard ratio 1⋅04, 95 per cent c.i. 0⋅96 to 1⋅12; P = 0⋅360). There were no significant differences in anastomotic leak rate (5⋅4 versus 4⋅6 per cent; P = 0⋅349) or acute kidney injury (14⋅3 versus 13⋅8 per cent; P = 0⋅666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35⋅3 versus 56⋅7 per cent; P < 0⋅001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.