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Surgical Robot-Assisted Transanal Specimen Extraction Radical Sigmoidectomy Without an Auxiliary Abdominal Incision

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Association Between Postoperative NSAID Use and Bleeding Following Transoral Robotic Surgery.

Brayden Seliger¹, Jacob Beiriger¹, Milana Berry¹

¹Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery

|April 30, 2026

Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) are safe after transoral robotic surgery (TORS), showing no increased bleeding risk. NSAID use in TORS patients also reduced critical care admissions and feeding tube needs.

Keywords:

NSAIDs enhanced recovery after surgery pain management postoperative hemorrhage transoral robotic surgery

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Area of Science:

Otolaryngology
Surgical Oncology
Pharmacology

Background:

Transoral robotic surgery (TORS) is a minimally invasive approach for head and neck cancers.
Postoperative pain management is crucial for recovery after TORS.
The role of nonsteroidal anti-inflammatory drugs (NSAIDs) in TORS recovery requires further investigation regarding safety and efficacy.

Purpose of the Study:

To evaluate the safety and clinical outcomes of NSAID administration following transoral robotic surgery (TORS).
To assess the association between NSAID use and postoperative hemorrhage, critical care admission, emergency department visits, and feeding device placement.
To determine if ketorolac administered on the day of surgery impacts postoperative outcomes.

Main Methods:

Retrospective cohort study utilizing the TriNetX multi-institutional database.
Propensity score matching was employed to compare NSAID users with control groups.
Patients undergoing TORS were analyzed, with cohorts defined by NSAID use (ketorolac, celecoxib, ibuprofen) within 14 days post-surgery and ketorolac on the day of surgery.

Main Results:

NSAID use was not associated with an increased risk of postoperative hemorrhage compared to controls.
Patients receiving NSAIDs demonstrated significantly lower rates of critical care admission and feeding tube placement.
No significant difference in emergency department visits was observed between NSAID and control groups. Day-of-surgery ketorolac also showed no increased bleeding risk.

Conclusions:

NSAID administration following TORS is safe and not linked to increased postoperative bleeding.
NSAID use in TORS patients is associated with reduced critical care utilization and decreased need for feeding tube placement.
These findings support the integration of NSAIDs into multimodal analgesia strategies for patients undergoing TORS.