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Increased risk for complications after colorectal surgery with selective cyclo-oxygenase 2 inhibitor etoricoxib
Tilman T Zittel1, Dan Razavi, Andras Papp
1Hudiksvall Hospital, Department of Surgery, Colorectal Section, Hudiksvall, Sweden. tilman.zittel@lio.se
Background:
Cyclo-oxygenase 2 inhibitors can be used for pain treatment after colorectal surgery.
Objective:
The aim of this study was to investigate whether the use of etoricoxib has negative effects on the perioperative outcome in colorectal surgery.
Design:
Complication data from an advanced medical database system were sampled prospectively, and patient records were reviewed retrospectively.
Patients:
All patients with elective colorectal surgery within an enhanced recovery after surgery protocol from 2008 to 2009 were selected.
Intervention:
The nonrandomized use of perioperative etoricoxib treatment was compared with a control group.
Main Outcome Measures:
The primary outcome measured was the number of patients with postoperative complications according to the Dindo-Clavien classification.
Results:
One hundred one patients received etoricoxib treatment, whereas 104 did not. The patient groups were very comparable. We observed a significant increase in the number of patients with postoperative complications with etoricoxib treatment (43 vs 30 patients; 42.6% vs 28.8%, p = 0.041) due to an increase in patients with a major complication (Dindo-Clavien complication grade III-V: 22.8% vs 9.6%, p = 0.01). Patients with etoricoxib treatment and a complication needed a longer recovery period than patients with a complication in the control group (18 (17; 20) vs 14 (13; 15) days, p = 0.05). We observed an increased level of postoperative serum creatinine with etoricoxib treatment (105 (98; 112) vs 82 (78; 85), p = 0.003), which was more pronounced in patients with a complication (141 (127; 155) vs 91 (83; 98), p = 0.002; 25 vs 8 patients with serum creatinine >100 μmol/L, p = 0.008). In multivariate analysis, etoricoxib was identified as an independent risk factor for experiencing a major complication with a risk increase of approximately 2.5-fold (p = 0.03).
Limitations:
This study was limited by the nonrandomized use of perioperative etoricoxib and the retrospective nature of its review of patient records.
Conclusions:
Etoricoxib increased the number of patients with postoperative complications and should be considered carefully in colorectal surgery.
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