Perioperative cyclooxygenase inhibition and postoperative pancreatic fistula after pancreatoduodenectomy: A systematic review and meta-analysis of comparative studies

Background: Nonsteroidal anti-inflammatory drug (NSAID) use has been investigated as a modifiable risk factor for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). This study comprises a systematic review and meta-analysis examining the impact of perioperative NSAID use on rates of POPF after PD. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-compliant systematic review was performed. Pooled mean differences (MD), odds ratios (OR), and risk ratios with 95% CIs were calculated. Results: Seven studies published from 2015 to 2021 were included, reporting 2851 PDs (1372 receiving NSAIDs and 1479 not receiving NSAIDs). There were no differences regarding blood loss (MD −99.40 mL; 95% CI, −201.71 to 2.91; P = .06), overall morbidity (OR 1.05; 95% CI, 0.68–1.61; P = .83), hemorrhage (OR 2.35; 95% CI, 0.48–11.59; P = .29), delayed gastric emptying (OR 0.98; 95% CI, 0.60–1.60; P = .93), bile leak (OR 0.68; 95% CI, 0.12–3.89; P = .66), surgical site infection (OR 1.02; 95% CI, 0.33–3.22; P = .97), abscess (OR 0.99; 95% CI, 0.51–1.91; P = .97), clinically relevant POPF (OR 1.18; 95% CI, 0.84–1.64; P = .33), readmission (OR 0.94; 95% CI, 0.61–1.46; P = .78), or reoperation (OR 0.82; 95% CI, 0.33–2.06; P = .68). NSAID use was associated with a shorter hospital stay (MD −1.05 days; 95% CI, −1.39 to 0.71; P < .00001). Conclusion: The use of NSAIDs in the perioperative period for patients undergoing PD was not associated with increased rates of POPF.