To the Editor We commend Hakkarainen and colleagues1 for their contribution to the ongoing discussion regarding the association of nonsteroidal anti-inflammatory drugs (NSAIDs) and anastomotic leak following gastrointestinal surgery.
A previous meta-analysis found NSAIDs are significantly associated with an increased risk for anastomotic leak.2 To our knowledge, the study by Hakkarainen et al is the first to suggest that this effect is limited to emergency colorectal patients only. These findings are based on a well-conducted analysis of clearly defined groups from a large prospective database. However, the patients in the NSAID group were significantly younger, with fewer comorbidities than the control arm, which makes it difficult to generate reliable effect estimates between treatment groups. Comparison between groups is further hindered by a lack of data on perioperative and postoperative variables known to be associated with anastomotic leak.3 Nonetheless, it would be interesting to perform a case-matched analysis of the data from Hakkarainen et al and use factors associated with anastomotic leakage to generate improved effect estimates.