Assessing the Risk of Postoperative Hemorrhage With NSAID Use After Transoral Robotic Surgery

The risk of postoperative hemorrhage (POH) with use of nonsteroidal anti-inflammatory drugs (NSAIDs) after trans-oral robotic surgery (TORS) oropharyngectomy is poorly described in the existing literature.

A retrospective propensity-matched cohort study was performed using the TriNetX database, with cohort assignments based on perioperative NSAID administration within 7 days of surgery.

1761 patients undergoing TORS oropharyngectomy were identified, and divided into two equal propensity-matched cohorts of 621. 660 patients (37.5%) received postoperative NSAIDs. The overall hemorrhage rate was 5.5%. There was no significant difference in primary POH (< 1.5% in the NSAID group and 1.2% in the group without NSAIDs), secondary POH (5.2% vs. 4.2%, OR = 1.243, 95% CI = 0.732, 2.112), emergency room (ER) presentation within 30 days (11.0% vs. 10.6%, OR = 1.034, 95% CI = 0.722, 1.480), or 30-day mortality (< 1.5% and < 0.9%).

In this study, NSAID use after TORS was not associated with an increased risk of primary or secondary POH, 30-day return to ER, or 30-day mortality rates. Only 37.5% of patients in this study received postoperative NSAIDS. NSAIDs may be underutilized in the treatment of post-TORS pain.