Effect of Non-Steroidal Anti-Inflammatory Drugs on Post-Surgical Complications Against the Backdrop of the Opioid Crisis

In 2018, Zhao-Fleming et al. reviewed the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on post-surgical complications, with a focus on their potential as an alternative to opioids for pain management. The review found that NSAIDs might negatively impact wound healing and could be associated with wound infections in animal studies, while human studies showed variable outcomes, particularly indicating that NSAIDs inhibit bone healing. The review also noted sex differences in response to NSAIDs, with inhibitory effects more commonly observed in females in animal studies, and called for caution when prescribing NSAIDs, especially to female patients. The document also discussed the controversial role of NSAIDs in anastomotic leaks, necrotizing soft tissue infections, bleeding complications, and orthopedic injuries, with some studies suggesting risks and others finding no significant relationship. The review concluded that NSAIDs may not affect soft tissue wound healing rates but should be used cautiously in long-bone fractures due to associations with non-union or delayed union. It also mentioned NSAIDs' chemopreventive role in cancer care, with a 20-40% risk reduction in colorectal cancer. Overall, the document emphasized the need for larger scale studies to make definitive recommendations and to better understand the differences in NSAID response between sexes.