Safety and Analgesic Outcomes of Nonsteroidal Anti-Inflammatory Drug-Containing Regimens After Transoral Robotic Surgery: A Systematic Review and Meta-Analysis.

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are increasingly used after transoral robotic surgery (TORS), but concerns regarding postoperative hemorrhage (POH) persist. This meta-analysis quantifies POH incidence and analgesic outcomes in NSAID-containing regimens after TORS. PubMed, Embase, and Scopus were searched through February 2026. Primary outcome was POH. Secondary outcomes included postoperative opioid administration and pain within 72 h, and discharge opioid prescribing. Random-effects models and sensitivity analyses addressing heterogeneity (prophylactic ligation and NSAID type) were used. Eight studies (n = 2519 patients) were included in the primary quantitative synthesis. One study was included qualitatively. POH incidence in NSAID cohorts (n = 1091) was 8.31% (95% CI: 4.91%-12.39%) and 6.77% (95% CI: 2.96%-11.70%) in cohorts excluding prophylactic ligation. NSAIDs did not significantly increase POH risk (RR 1.56, p = 0.1768). NSAIDs reduced 72-h pain scores (standardized mean difference [SMD] -0.88), inpatient opioid administration (SMD -1.06), and discharge prescriptions. NSAIDs improved analgesia and reduced opioid use after TORS without significantly increasing POH risk, supporting NSAID integration into postoperative protocols.