Within the past week, STARSurg has published its latest study in the World Journal of Surgery, looking at the safety of non-steroidal anti-inflammatory drugs (NSAIDs) in major gastrointestinal surgery. Our new paper arose directly as a result of the DISCOVER project, with all DISCOVER collaborators citable on the new paper. This area is hotly debated at present in the field of general surgery, due to concerns about the apparent association between increased anastomotic leak rates and NSAIDs in some observational studies. Our study found no such associations between increased rates of anastomotic leak and NSAID use. There are multiple reasons this may be the case. Most of the studies which have found this association have been observational in nature, similar to ours. Selection bias is a key factor in these studies, particularly when considering NSAIDs. Patients who have multiple co-morbidities are unlikely to receive NSAIDs, as common perceptions amongst clinicians link NSAIDs with Acute Kidney Injury, gastrointestinal bleeding and heart failure. Subsequently, patients receiving NSAIDs may be fitter or undergoing operations which are more ‘minor’- that is to say, with fewer anastomoses and less contamination. This multitude of factors combine to introduce selection bias into the results of any observational study.
Where STARSurg differs is that we have employed a technique called propensity score matching. For those familiar with the inaugural STARSurg paper on the same topic, this is what we used in that paper too! Propensity score matching reduces selection bias by matching control and NSAID treated patients based on multiple clinical characteristics that may lead to selection bias. Therefore, short of a randomised trial, we can say the results of our study are nearer to the true estimate of the effect.
In this study, we showed NSAIDs to be safe in patients undergoing gastrointestinal surgery. Nevertheless, evidence is still conflicting and a large randomised trial is required to address key questions on safety. Addressing these issues will lead to safer patient care and perhaps even allow improvements in analgesic regimens for the general surgical patient, with STARSurg, yet again at the forefront of innovation.
Take a look at the NSAIDs safety paper here:
http://link.springer.com/article/10.1007%-016-3727-3

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