Safety of Celecoxib in Postoperative Patients With Documented Sulfonamide Allergies

Celecoxib is commonly used for postoperative analgesia because of its favorable adverse effect profile compared with other nonsteroidal anti-inflammatory drugs. However, its use is often restricted in patients labeled as sulfonamide ("sulfa") allergic due to persistent electronic health record warnings, despite contemporary evidence showing minimal risk of immunologic cross-reactivity. The purpose of this study was to evaluate the safety of postoperative celecoxib administration in orthopaedic patients with documented sulfonamide allergies.

A retrospective cohort study was conducted at a single tertiary academic center. Orthopaedic surgery patients from January 1, 2020, to December 31, 2022, with a documented sulfonamide allergy who received celecoxib postoperatively were included. All postoperative clinic notes, telephone encounters, and emergency department records from surgery through the second follow-up visit were reviewed to identify allergic reactions.

Sixty-one patients met inclusion criteria (mean age, 52.6 ± 15.7 years; 67.2% female). The mean time to the first and second postoperative visits was 17 ± 7 and 49 ± 19 days, respectively. Thirteen patients (21.3%) presented to the emergency department during follow-up for issues, including postoperative pain or swelling, gastrointestinal complaints, constipation, unrelated trauma, or noncardiac chest pain. Two patients experienced allergic reactions attributed to perioperative antibiotics or surgical adhesive. One patient (1.6%) sustained a gastrointestinal bleed while also taking aspirin for thromboprophylaxis. No allergic reactions were attributable to celecoxib.

Celecoxib was safely administered to patients with documented sulfonamide allergies, with no evidence of cross-reactivity. Given its analgesic benefits and overall safety profile, routine avoidance of celecoxib in sulfa-allergic patients appears unnecessary. Updating electronic health record decision-support logic to reflect current evidence may reduce alert fatigue and support more effective multimodal pain management.