Perioperative non-steroidal anti-inflammatory drugs (NSAID) administration and acute kidney injury (AKI) in major gastrointestinal surgery: A prospective, multicenter, propensity matched cohort study

STARSurg Collaborative

Research output: Contribution to journalArticlepeer-review

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are a component of the WHO pain ladder and are commonly used in the postoperative setting1,2. Their opioid-sparing and anti-inflammatory effects have potential to improve recovery following major abdominal surgery3. However, NSAIDs have previously been associated with increased risk of acute kidney injury (AKI), anastomotic leak, cardiovascular events, and gastrointestinal side effects such as colitis, ulceration, and bleeding4–8.

Postoperative AKI occurs in around 1 in 6 patients following major abdominal surgery and is associated with increased postoperative mortality both at 30 days and 1 year9,10. NSAIDs inhibit renal prostaglandins, impairing renal homeostasis6. This may increase the risk of AKI in the event of hypovolemia, blood loss, or sepsis, all of which can occur in the early postoperative period. Previous observational studies exploring the association between NSAID use and AKI have reported conflicting findings1,8,11. However, the outcome definitions of AKI in these studies were heterogenous and low rates of AKI suggest that AKI outcome detection was poor.

In order to ensure that effective analgesics are not unnecessarily withheld from postoperative patients, the safety of NSAIDs needs to be determined in the postoperative setting. There remain concerns regarding the use of NSAIDs around the time of gastrointestinal surgery, including whether NSAID use leads to AKI and anastomotic leak4,8. The primary aim of this study was to investigate the relationship between early NSAID administration and postoperative AKI following major gastrointestinal surgery. The secondary aim was to investigate the association between early NSAID use and anastomotic leak.
Original languageEnglish
JournalAnnals of Surgery
Publication statusPublished - 14 Oct 2020
Externally publishedYes

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