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Diseases of the colon and rectum

Increased risk for complications after colorectal surgery with selective cyclo-oxygenase 2 inhibitor etoricoxib.


PMID 23652751

Abstract

Cyclo-oxygenase 2 inhibitors can be used for pain treatment after colorectal surgery. The aim of this study was to investigate whether the use of etoricoxib has negative effects on the perioperative outcome in colorectal surgery. Complication data from an advanced medical database system were sampled prospectively, and patient records were reviewed retrospectively. All patients with elective colorectal surgery within an enhanced recovery after surgery protocol from 2008 to 2009 were selected. The nonrandomized use of perioperative etoricoxib treatment was compared with a control group. The primary outcome measured was the number of patients with postoperative complications according to the Dindo-Clavien classification. 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). This study was limited by the nonrandomized use of perioperative etoricoxib and the retrospective nature of its review of patient records. Etoricoxib increased the number of patients with postoperative complications and should be considered carefully in colorectal surgery.

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