Bleeding risk from nonsteroidal anti-inflammatory drugs after functional endoscopic sinus surgery: Analysis of the TriNetX database

ObjectivesPostoperative pain medications and aspirin before undergoing functional endoscopic sinus surgery (FESS) are managed carefully due to concern for bleeding. Little is known regarding the increase in the risk of bleeding for patients unable to stop aspirin as trials are limited in this area. We compared outcomes for patients undergoing FESS who were managed postoperatively with nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids. We also determined the epistaxis rate for patients on aspirin at the time of surgery compared to those who were not on aspirin.Data SourceRetrospective analysis of patients undergoing FESS using the TriNetX database.MethodsPatients were propensity-matched, and the odds of bleeding complications between the patients prescribed postoperative NSAIDs were compared to those prescribed opioids. We also compared postoperative odds of bleeding in patients unable to halt aspirin use at the time of surgery to those who were not on aspirin before surgery.ResultsA total of 51,361 patients received opioids after FESS compared to 1923 patients who received NSAIDs. After propensity matching, 1918 patients were in each group and odds of epistaxis were similar between the NSAID group and the opioid group (odds ratio [OR]: 1.32, 95% confidence interval (CI): 0.90-1.94); 7.67% of the NSAID group required rescue opioids. Patients on aspirin who were unable to hold aspirin at surgery showed bleeding rates of 14.67% compared to 9.00% in propensity-matched controls who were not on aspirin (OR: 1.74, 95%CI: 1.20-2.51).ConclusionsNSAID use appears to be a safe alternative to opioids for patients without pre-existing risk factors for bleeding. Patients who remained on aspirin in the week before FESS had an increased risk of postoperative epistaxis. Compared to opioids, nonsteroidal anti-inflammatory drugs do not appear to increase the odds of bleeding after functional endoscopic sinus surgery. Aspirin use before sinus surgery increases the odds of bleeding by 74%.