Risk of Gastrointestinal Bleeding With Extended Use of Nonsteroidal Anti-Inflammatory Drug Analgesia After Joint Arthroplasty

Fleischman, Andrew N.; Li, William T.; Luzzi, Andrew; Nest, Duncan S. Van; Torjman, Marc C.; Schwenk, Eric S.; Arnold, William A.; Parvızı, Javad

doi:10.1016/j.arth.2021.02.015

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…It has previously been theorized that the implementation of enhanced recovery pathways may reduce the number of GI-complications [17], as several elements such as multimodal analgesia, early mobilization, only in-hospital thromboprophylaxis and reduced need of hospitalization may reduce the risks of GI-complications such as GIB and constipation [17][18][19] as demonstrated in our study. Thromboprophylaxis after THA and TKA surgery is a complicated task due to the opposite risks of VTE and GIB, which was the most common GI-complication in our cohort.…”

Section: Discussionsupporting

confidence: 64%

“…This increased risk may be related to the use of thromboprophylaxis, although most patients received subcutaneous low molecular weight heparin, which is generally not associated with a higher risk of GIB [ 3 ]. In addition, NSAIDS, which are often used in a multi-modal opioid-sparing protocol, have not been found to increase the risk of GIBs after THA or TKA if appropriate precautions are taken as it pertains to patients with a higher risk of GIB [ 19 ]. The individual pain treatment plans and use of proton-pump inhibitors were not reviewed in this study.…”

Section: Discussionmentioning

confidence: 99%

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Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort

Daugberg

Kehlet

Petersen

et al. 2023

Arch Orthop Trauma Surg

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Introduction Gastrointestinal complications after total hip (THA) and knee arthroplasty (TKA) have been reported to be between 0.3 and 2.6% with bleeding and C. difficile infection in 0–1%, and 0.1–1.7%, respectively. The use of enhanced recovery or “fast-track” protocols have focused on optimizing all aspects of perioperative care resulting in reduced length of hospital stay (LOS) and potentially also gastrointestinal complications. This study is a detailed analysis on the occurrence of postoperative gastrointestinal complications resulting in increased hospital stay or readmissions in a large consecutive cohort of fast-track THA and TKA with complete 90 days follow-up. Materials and methods This is an observational study on a consecutive cohort of primary unilateral THAs and TKAs performed between January 2010 and August 2017 in nine Danish high-volume fast-track centers. Discharge summaries and relevant patient records were reviewed in patients with readmissions within 90 days or LOS > 4 days caused by gastrointestinal complications. Results The cohort included 36,932 patients with 58.3% females and 54.1% THAs. Mean age and BMI were 68 years and 28. Median postoperative LOS was 2 days. Only n: 276 (0.75 %) had a LOS > 4 days or a readmission within 90 days due to a gastrointestinal complication (CI 0.67%–0.84%). Of these, only 34 (0.09%) were graded as severe ileus or gastrointestinal bleeding. Conclusions The risk of GI-complications within the first 90 postoperative days after fast-track THA and TKA was low (0.75%).

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort

Daugberg

Kehlet

Petersen

et al. 2023

Arch Orthop Trauma Surg

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“…In contrast to the data on AKI and strokes, there is a lack of consensus in the prior literature regarding the examining of postoperative GI bleeding associated with NSAID use. Fleischmann et al found no association with non-aspirin NSAID use but found an increased risk of GI bleeding with aspirin; in anticoagulants such as warfarin; direct oral anticoagulants; and antiplatelet agents [13]. Several studies have suggested a preoperative GI diagnosis of reflux or peptic ulcer disease is associated with an increased risk of postoperative GI bleeding; however, aspirin is not associated with an increased risk of GI bleeding, irrespective of preoperative GI diagnosis [14][15][16]32].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there is a paucity in the literature regarding characterizing the complications associated with combined NSAID usage, which is an increasingly common practice in modern analgesia pathways [12]. Multiple studies have looked at NSAID use and the association with AKI, GI bleeds, and strokes following THA and TKA [13][14][15][16]. However, these studies were limited by a focus on a single NSAID, or by grouping all NSAIDs together without parsing out the specific risks associated with each combination [13,17,18].…”

Section: Introductionmentioning

confidence: 99%

“…Multiple studies have looked at NSAID use and the association with AKI, GI bleeds, and strokes following THA and TKA [13][14][15][16]. However, these studies were limited by a focus on a single NSAID, or by grouping all NSAIDs together without parsing out the specific risks associated with each combination [13,17,18]. A recently published single-institution study examined the renal complications of the combined use of ibuprofen with aspirin, but it did not investigate other postoperative complications nor other combinations of NSAIDs [19].…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Complications Associated with Non-Steroidal Anti-Inflammatory Combinations Used Status-Post Total Hip and Knee Arthroplasty

Nakata,

Shelby,

Wang

et al. 2023

JCM

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Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in multimodal pain control following total joint arthroplasty (TJA). However, few studies have assessed the complications associated with the combinations of NSAIDs in this population despite the known risks associated with this class of medications. The Premier Healthcare Database was queried to identify adults who underwent primary total hip or knee arthroplasty from 2005–2014. The following most common inpatient combinations of NSAIDs were chosen for analysis: aspirin + celecoxib (A + C), toradol + aspirin (T + A), toradol + ibuprofen (T + I), celecoxib + ibuprofen (C + I), ibuprofen + aspirin (I + A), and toradol + celecoxib (T + C). Primary outcomes included acute kidney injury (AKI), gastrointestinal bleed, and stroke. Secondary outcomes included periprosthetic joint infection (PJI), deep vein thrombosis, and pulmonary embolism. Univariate and multivariate regression analyses were used to compare differences and address confounds. Overall, 195,833 patients were identified. After controlling for confounds, increased odds of AKI was associated with A + C (adjusted odds ratio [aOR]: 1.20, 95% confidence interval [CI]: 1.09–1.34, p < 0.001) and decreased odds was associated with T + A (aOR 0.76, 95% CI: 0.69–0.83, p < 0.001). Increased odds of stroke was associated with A + C (aOR: 1.80, 95% CI: 1.15–2.84, p = 0.011); T + I (aOR 3.48, 95% CI: 1.25–9.73, p = 0.017); and I + A (aOR 4.29, 95% CI: 1.06–17.9, p = 0.046). Increased odds of PJI was associated with C + I (aOR: 10.3, 95% CI: 1.35–78.3, p = 0.024). In the TJA patient population, NSAID pairings should be regarded as distinct entities. Our results suggest that combinations including A + C, T + I, I + A, and C + I should be used cautiously. With this knowledge, providers should consider tailoring NSAID prescriptions appropriately.

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Hospital Readmissions After Total Joint Arthroplasty: An Updated Analysis and Implications for Value-Based Care

Metoxen

Ferreira²,

Zhang³

et al. 2023

The Journal of Arthroplasty

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Risk of Gastrointestinal Bleeding With Extended Use of Nonsteroidal Anti-Inflammatory Drug Analgesia After Joint Arthroplasty

Cited by 4 publications

References 26 publications

Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort

Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort

Postoperative Complications Associated with Non-Steroidal Anti-Inflammatory Combinations Used Status-Post Total Hip and Knee Arthroplasty

Hospital Readmissions After Total Joint Arthroplasty: An Updated Analysis and Implications for Value-Based Care

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