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CERTAIN Study Finds Common Drug for Treating Pain May Lead to Complications in Certain Surgical Procedures

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drugs used regularly to treat inflammation and reduce pain. As doctors try to avoid negative effects associated with opioid medications, the use of intravenous NSAIDs for treating pain after surgery has increased. But over the past decade, several small studies have shown a connection between NSAID use and complications with healing for surgeries involving the gastrointestinal tract.

To better understand this connection, CERTAIN investigators looked at hospital data for more than 13,000 patients who underwent bariatric or colorectal procedures between 2006 and 2010 in Washington State. As the researchers peered into the data, they found that patients who received NSAIDs did, in fact, experience a higher rate of anastomotic leak (when sections of the intestine are joined together surgically, but the new connection does not heal properly and leaks). Surprisingly, this complication was prevalent only in patients who underwent non-elective (i.e., emergency or urgent) surgery, but not for elective (i.e., planned) procedures.

The authors of this study acknowledge that further research is needed to better understand the association of NSAID use and anastomotic complications. But considering that other pain treatments are effective and well tolerated, the authors conclude that these findings may be enough to encourage surgeons to alter their practice—especially for patients undergoing non-elective colorectal surgery.

Read the full manuscript here: Nonsteroidal Anti-inflammatory Drugs and the Risk for Anastomotic Failure: A Report From Washington State’s Surgical Care and Outcomes Assessment Program (SCOAP)

UPDATE: This manuscript was discussed as part of a two-day International General Surgery Journal Club tweetchat on March 10th and 11th. The tweetchat had over 40 active participants and earned 1,126,073 impressions. JAMA made the article free to download for the month of March.


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  • CERTAIN Medical Director Dr. David Flum on The Conversation with Ross Reynolds 4/11/12: listen here.