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Perioperative COX-2 inhibitors may increase the risk of post-operative acute kidney injury

Journal article
Authors A. Abrahamsson
Jonatan Oras
Johan Snygg
Linda Block
Published in Acta Anaesthesiologica Scandinavica
Volume 61
Issue 7
Pages 714-721
ISSN 0001-5172
Publication year 2017
Published at Institute of Clinical Sciences, Section for Anesthesiology, Biomaterials and Orthopaedics. Department of Anesthesiology and Intensive care
Institute of Clinical Sciences
Pages 714-721
Language English
Links doi.org/10.1111/aas.12912
Keywords enhanced recovery, surgical-patients, renal-failure, pancreaticoduodenectomy, metaanalysis, creatinine, surgery, Anesthesiology
Subject categories Clinical Medicine

Abstract

BackgroundIn enhanced recovery protocols (ERP), a restrictive fluid regimen is proposed. Patients who undergo major surgery have an increased risk of post-operative acute kidney injury (AKI). This combination may pose difficulties when ERP is used for patients undergoing major surgery. The aim of this study was to evaluate whether patients undergoing pancreatic surgery and treated with a restrictive fluid regimen are at greater risk of post-operative AKI. Furthermore, if there was an increased risk of AKI, we aimed to identify its cause. MethodsWe reviewed the medical records of patients who underwent pancreatic surgery during 2014 (preERP, n = 58) and 2015 (ERP, n = 65). Fluid balance, the administration of cyclooxygenase-2 inhibitors, creatinine levels and mean arterial pressure were recorded. The Kidney Disease: Improving Global Outcomes criteria were used to define AKI. ResultsThe incidence of AKI was higher in the ERP group than in the PreERP group (12.5% vs. 1.8%, respectively, P = 0.035). The increased incidence of AKI could not be explained by differences in comorbidities, age, pre-operative creatinine or perioperative hypotension. Administration of coxibs was higher in the ERP group and was associated with increased incidence of post-operative AKI (P = 0.018). The combination of coxibs and restrictive fluid regimen seems particularly harmful. ConclusionPancreatic surgery with a restrictive fluid regimen carries an increased risk of post-operative AKI if patients are also treated with cyclooxygenase-2 inhibitors. It is therefore suggested that in protocols including a restrictive fluid regimen for open pancreatic surgery, the use of cyclooxygenase-2 inhibitors should be avoided.

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