Abstract:
IMPORTANCE:Nonsteroidal anti-inflammatory drugs (NSAIDs) have many physiologic effects and are being used more commonly to treat postoperative pain, but recent small studies have suggested that NSAIDs may impair anastomotic healing in the gastrointestinal tract. OBJECTIVE:To evaluate the relationship between postoperative NSAID administration and anastomotic complications. DESIGN, SETTING, AND PARTICIPANTS:Retrospective cohort study of 13,082 patients undergoing bariatric or colorectal surgery at 47 hospitals in Washington State from January 1, 2006, through December 31, 2010, using data from the Surgical Care and Outcomes Assessment Program linked to the Washington State Comprehensive Abstract Reporting System. EXPOSURE:NSAID administration beginning within 24 hours after surgery. MAIN OUTCOMES AND MEASURES:We used multivariate logistic regression modeling to assess the risk for anastomotic complications (reoperation, rescue stoma, revision of an anastomosis, and percutaneous drainage of an abscess) through 90 days after bariatric and colorectal surgery involving anastomoses. RESULTS:Of the 13,082 patients (mean [SD] age, 58.1 [15.8] years; 60.7% women), 3158 (24.1%) received NSAIDs. The overall 90-day rate of anastomotic leaks was 4.3% for all patients (151 patients [4.8%] in the NSAID group and 417 patients [4.2%] in the non-NSAID group; P=.16). After risk adjustment, NSAIDs were associated with a 24% increased risk for anastomotic leak (odds ratio, 1.24 [95% CI, 1.01-1.56]; P=.04). This association was isolated to nonelective colorectal surgery, for which the leak rate was 12.3% in the NSAID group and 8.3% in the non-NSAID group (odds ratio, 1.70 [95% CI, 1.11-2.68]; P=.01). CONCLUSIONS AND RELEVANCE:Postoperative NSAIDs were associated with a significantly increased risk for anastomotic complications among patients undergoing nonelective colorectal resection. To determine the role of NSAIDs in colorectal surgery, future evaluations should consider specific formulations, the dose effect, mechanism, and other relevant outcome domains, including pain control, cardiac complications, and overall recovery.
journal_name
JAMA Surgjournal_title
JAMA surgeryauthors
Hakkarainen TW,Steele SR,Bastaworous A,Dellinger EP,Farrokhi E,Farjah F,Florence M,Helton S,Horton M,Pietro M,Varghese TK,Flum DRdoi
10.1001/jamasurg.2014.2239subject
Has Abstractpub_date
2015-03-01 00:00:00pages
223-8issue
3eissn
2168-6254issn
2168-6262pii
2091774journal_volume
150pub_type
杂志文章相关文献
JAMA Surgery文献大全abstract:OBJECTIVE:To evaluate the performance of 3-dimensional (3D) virtual neck exploration (VNE) as a modality for preoperative localization of parathyroid adenomas in primary hyperparathyroidism and assess the feasibility of using augmented reality to guide parathyroidectomy as a step toward minimally invasive imageguided s...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.739
更新日期:2013-03-01 00:00:00
abstract:Importance:Assessment of physical frailty in older trauma patients admitted to the intensive care unit is often not feasible using traditional frailty assessment instruments. The use of opportunistic computed tomography (CT) scans to assess sarcopenia and osteopenia as indicators of underlying frailty may provide compl...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.4604
更新日期:2017-02-15 00:00:00
abstract:Importance:Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking. Objective:To assemble a multidisciplinary team of health care experts an...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.5045
更新日期:2021-01-01 00:00:00
abstract:Importance:Fluorescent imaging with indocyanine green can be used to visualize lymphatics. Peritumoral injection of indocyanine green may allow for visualization of every draining lymph node from a primary lesion on near-infrared imaging. Objectives:To evaluate the role of fluorescent lymphography using near-infrared ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.4267
更新日期:2019-02-01 00:00:00
abstract:Importance:All events that transpire during laparoscopic cholecystectomy (LC) cannot be adequately reproduced in the operative note. Video recording is already known to add important information regarding this operation. Objective:It is hypothesized that additional audio recordings can provide an even better procedura...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.0741
更新日期:2020-07-01 00:00:00
abstract:Importance:Surgical care is widely unavailable in developing countries; advocates recommend that countries evaluate and report on access to surgical care to improve availability and aid health planners in decision making. Objective:To analyze the infrastructure, capacity, and availability of surgical care in Zambia to...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.2303
更新日期:2016-11-01 00:00:00
abstract:Importance:There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty. Yet, little consensus supports the effectiveness of these interventions. Objective:To systematically review and meta-analyze evidence of nonpharmacological interventions for postoperative pain manageme...
journal_title:JAMA surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamasurg.2017.2872
更新日期:2017-10-18 00:00:00
abstract:Importance:Autologous fat transfer (AFT or fat grafting) has become an invaluable tool for the correction of disfiguring deformities after breast cancer surgery. However, clinical and animal studies have shown conflicting results regarding its oncologic safety. Objective:To determine whether exposure to AFT vs convent...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.3744
更新日期:2019-01-01 00:00:00
abstract:IMPORTANCE:Endovascular technology has become ubiquitous in the modern care of abdominal aortic aneurysm (AAA), yet broad estimates of its efficacy among variable hospital and regional settings is not known. OBJECTIVE:To perform a preliminary analysis of hospital effects on mortality following open AAA repair (OAR) an...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2014.3871
更新日期:2015-07-01 00:00:00
abstract:IMPORTANCE:To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. OBJECTIVE:To assess the effect of different types of bariatric surgery in patients with T2DM on diabetes remis...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2015.2398
更新日期:2015-12-01 00:00:00
abstract:IMPORTANCE:In recent years, the CD40/CD40L system has been implicated in the pathophysiology of severe chronic inflammatory diseases. Recently, obesity has been described as a low chronic inflammatory disease, so this system could also be involved in the inflammatory process. OBJECTIVE:To study soluble CD40 ligand (sC...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurgery.2013.419
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVES:To describe the current state of the science for operating room (OR) briefings and debriefings, including an overview of key definitions, a review of the evidence of effectiveness, and a summary of our experiences as part of a comprehensive unit-based safety program. OVERVIEW:Use of preoperative briefings h...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.172
更新日期:2014-08-01 00:00:00
abstract:Importance:Medically treated symptomatic severe aortic stenosis has poor outcomes, and in the past 6 decades, it has successfully been treated with surgical aortic valve replacement (SAVR). However, one-third of patients with indications for SAVR are not offered surgery because of the high risk of complications. Transc...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.4449
更新日期:2019-11-27 00:00:00
abstract::Over the past decade, minimally invasive surgery has been introduced as a means to allow manipulation of delicate tissues with outstanding visualization of the surgical field. The purpose of this article is to review the available literature regarding early postoperative outcomes and the technical challenges of minima...
journal_title:JAMA surgery
pub_type: 杂志文章,评审
doi:10.1001/jamasurg.2013.366
更新日期:2013-12-01 00:00:00
abstract:Importance:To our knowledge, thyroid cancer incidence is increasing faster than any other cancer type and is currently the fifth most common cancer among women. While this rise is likely multifactorial, there has been scarce consideration of the effect of insurance statuses on the treatment of thyroid cancer. Objectiv...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2017.0461
更新日期:2017-08-01 00:00:00
abstract:Importance:Surgery represents the mainstay treatment of colorectal liver metastases. Indications for the laparoscopic approach in this setting have been widened and there is a need to confirm the benefits of minimally invasive liver surgery (MILS) in patients with complex disease states. Objective:To compare outcomes ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.2107
更新日期:2018-11-01 00:00:00
abstract:IMPORTANCE:The Centers for Medicare and Medicaid Services have implemented penalties for hospitals with above-average readmission rates under the Hospital Readmissions Reductions Program. These changes will likely be extended to affect postoperative readmissions in the future. OBJECTIVES:To identify variables that pla...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.4043
更新日期:2015-06-01 00:00:00
abstract:Importance:There is limited literature reporting circumstances surrounding end-of-life care in vascular surgery patients. Objective:To identify factors driving end-of-life decisions in vascular surgery patients. Design, Setting, and Participants:In this cohort study, medical records were reviewed for all vascular sur...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.3970
更新日期:2017-02-01 00:00:00
abstract:Importance:Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives:To evaluate if abstinence from smoking on the day of surgery is associated with a decreased frequency ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.5704
更新日期:2017-05-01 00:00:00
abstract:IMPORTANCE:Although prospective randomized data are available to guide the multidisciplinary management of soft tissue sarcoma (STS) of the extremities, controversy exists regarding adjuvant chemotherapy and radiation therapy. OBJECTIVE:To determine if clinical specialty introduces bias in recommendations for multimod...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.113
更新日期:2013-07-01 00:00:00
abstract:IMPORTANCE:The field of transplantation has made tremendous progress since the first successful kidney transplant in 1954. OBJECTIVE:To determine the survival benefit of solid-organ transplant as recorded during a 25-year study period in the United Network for Organ Sharing (UNOS) database and the Social Security Admi...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.2038
更新日期:2015-03-01 00:00:00
abstract:IMPORTANCE:A physician-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems. OBJECTIVE:To use human factors engineering to redesign the trauma process based on previously identified impediments to care related to coordination problems, c...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.1208
更新日期:2014-09-01 00:00:00
abstract:IMPORTANCE:In an era of accountable care, understanding variation in health care costs is critical to reducing health care spending. OBJECTIVE:To identify factors associated with increased hospital costs and quantify variations in costs among individual hospitals in patients undergoing liver and pancreatic surgery in ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2015.3618
更新日期:2016-02-01 00:00:00
abstract:IMPORTANCE:Obesity has been associated with impairments in sexual function and untoward changes in reproductive hormones in women. Relatively few studies have investigated changes in these domains following bariatric surgery. OBJECTIVE:To investigate changes in sexual functioning, sex hormone levels, and relevant psyc...
journal_title:JAMA surgery
pub_type: 临床试验,杂志文章
doi:10.1001/jamasurg.2013.5022
更新日期:2014-01-01 00:00:00
abstract:Importance:Adhesive small-bowel obstruction (aSBO) is a potentially chronic, recurring surgical illness. Although guidelines suggest trials of nonoperative management, the long-term association of this approach with recurrence is poorly understood. Objective:To compare the incidence of recurrence of aSBO in patients u...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.5248
更新日期:2019-05-01 00:00:00
abstract:Importance:Motor vehicle crashes (MVCs) are a leading public health concern. Emergency medical service (EMS) response time is a modifiable, system-level factor with the potential to influence trauma patient survival. The relationship between EMS response time and MVC mortality is unknown. Objectives:To measure the ass...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.5097
更新日期:2019-04-01 00:00:00
abstract:Importance:Primary hyperparathyroidism (pHPT) is a common clinical entity, with approximately 100 000 new cases diagnosed each year in the United States. Most patients with pHPT have a relatively mild form of the disease and present with few if any overt signs or symptoms. This has led to a dilemma regarding which pati...
journal_title:JAMA surgery
pub_type: 杂志文章,评审
doi:10.1001/jamasurg.2017.1721
更新日期:2017-09-01 00:00:00
abstract:IMPORTANCE:The introduction of hepatoprotective strategies and multidisciplinary management has significantly improved the outcome of neonates with short bowel syndrome (SBS) who require parenteral nutrition (PN). OBJECTIVE:To determine the probability of weaning from PN based on intestinal length in neonates with SBS...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.4332
更新日期:2014-07-01 00:00:00
abstract:Importance:The United States is experiencing an opioid abuse epidemic. Opioid overprescription by physicians may contribute to this epidemic. Objectives:To determine if there was a correlation between a postoperative patient's 24-hour predischarge opioid use and the amount of opioids prescribed at hospital discharge a...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2017.4859
更新日期:2018-02-21 00:00:00
abstract:Importance:Surgical and medical device manufacturers have a cooperative relationship with clinicians. When evaluating published works, one should assess the integrity and academic credentials of the authors, who serve as putative experts. A relationship with a relevant manufacturer may increase the potential risk for b...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.2576
更新日期:2018-11-01 00:00:00