Safety of selective COX-2 inhibitors in tonsillectomy patients: a systematic review protocol

OBJECTIVE: This review aims to assess the safety of selective cyclooxygenase-2 (COX-2) inhibitors in tonsillectomy patients. INTRODUCTION: Recovery after tonsillectomy is painful and requires robust multimodal analgesia to manage; however, there is a risk of bleeding with nonsteroidal anti-inflammatory drugs (NSAIDs). Selective COX-2 inhibitors are theoretically safe due to minimal COX-1 antiplatelet effect; however, their safety as a subclass of medication in tonsillectomy patients has not been well established despite multiple published experimental studies. ELIGIBILITY CRITERIA: The review will consider studies that assess patients of any age undergoing tonsillectomy or adenotonsillectomy, treated with an NSAID that is more selective for COX-2 than COX-1. The primary relevant outcome is the incidence of post-tonsillectomy bleeding. METHODS: The review will follow the JBI methodology for systematic reviews of effectiveness. The search strategy will include searches of CINAHL (EBSCOhost), the Cochrane Library, Embase (Ovid), MEDLINE (Ovid), SciELO, and Web of Science Core Collection. Studies will be assessed by 2 reviewers independently against the eligibility criteria. Studies of any date, language, or methodological quality may be included for data extraction. The standard JBI methodology for critical appraisal will be used. Effect sizes will be expressed as odds ratios, and subgroup analyses will be used to identify and manage differences in study design and patient cohorts. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach for grading certainty of evidence will be followed. REVIEW REGISTRATION: PROSPERO CRD42024577071.