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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: NSAIDs improved analgesia and reduced opioid use after TORS without significantly increasing POH risk, supporting NSAID integration into postoperative protocols.