Miao Tyson, Lee Lik Hang N, Sun Terri, Patapoff Megan, Wang Erica
Department of Pharmacy, Surrey Memorial Hospital, 13750 96 Ave, Surrey, BC, V3V 1Z2, Canada.
Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.
Can J Anaesth. 2025 Jun 25. doi: 10.1007/s12630-025-02983-7.
Pain management after cardiac surgery is imperative, as inadequate analgesia can increase the risk of myocardial ischemia, thromboembolism, and pulmonary complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are an important component of multimodal analgesia, but their use in the postoperative cardiac surgery population is controversial owing to concerns of acute kidney injury (AKI), thrombotic events, and bleeding. We aimed to evaluate the rate of AKI, major adverse cardiovascular events (MACE), and major bleeding in patients receiving NSAIDs early after cardiac surgery.
We conducted a single-centre historical cohort study, which included adult patients who underwent cardiac surgery with sternotomy or thoracotomy between 1 October 2020 and 30 September 2022 and received nonselective NSAIDs postoperatively. The primary outcome was the proportion of patients who developed AKI, MACE, or major bleeding within 7 days of the NSAID exposure during their hospitalization. We used machine learning to identify risk factors associated with adverse events. We assessed pain reduction by analyzing differences in pain scores, opioid use, and supplemental oxygen requirements.
We included 431 patients in this study. After NSAID administration, 12% experienced AKI, 1% had MACE, and 3% developed major bleeding. Risk factors for AKI included older age; shorter height; a history of stroke; low preoperative estimated glomerular filtration rate (eGFR) and hemoglobin level; high preoperative platelet count, international normalized ratio, and blood urea nitrogen level; and reduced eGFR and platelet count before NSAID exposure.
In patients who received nonselective NSAIDs early after cardiac surgery, the rate of AKI was lower than reported in literature, likely due to selection bias. Baseline renal function emerged as the most important factor, with low preoperative eGFR being the strongest predictor of AKI following NSAID administration.
心脏手术后的疼痛管理至关重要，因为镇痛不足会增加心肌缺血、血栓栓塞和肺部并发症的风险。非甾体抗炎药（NSAIDs）是多模式镇痛的重要组成部分，但由于担心急性肾损伤（AKI）、血栓形成事件和出血，其在心脏手术后患者中的使用存在争议。我们旨在评估心脏手术后早期接受NSAIDs治疗的患者发生AKI、主要不良心血管事件（MACE）和大出血的发生率。
我们进行了一项单中心历史性队列研究，纳入了2020年10月1日至2022年9月30日期间接受胸骨切开术或开胸心脏手术并在术后接受非选择性NSAIDs治疗的成年患者。主要结局是在住院期间NSAIDs暴露后7天内发生AKI、MACE或大出血的患者比例。我们使用机器学习来识别与不良事件相关的风险因素。我们通过分析疼痛评分、阿片类药物使用和补充氧气需求的差异来评估疼痛减轻情况。
本研究纳入了431例患者。给予NSAIDs后，12%的患者发生AKI，1%的患者发生MACE，3%的患者发生大出血。AKI的风险因素包括年龄较大、身高较矮、有中风病史、术前估计肾小球滤过率（eGFR）和血红蛋白水平较低、术前血小板计数、国际标准化比值和血尿素氮水平较高，以及NSAIDs暴露前eGFR和血小板计数降低。
在心脏手术后早期接受非选择性NSAIDs治疗的患者中，AKI的发生率低于文献报道，可能是由于选择偏倚。基线肾功能是最重要的因素，术前eGFR较低是NSAIDs给药后AKI的最强预测因素。
