Perioperative ketorolac use and postoperative acute kidney injury in elderly patients undergoing noncardiac surgery: a retrospective cohort study

The use of nonsteroidal anti-inflammatory drugs, particularly ketorolac, in elderly patients is not recommended due to concerns about acute kidney injury (AKI). However, the effect of perioperative ketorolac use on postoperative AKI in elderly patients remains uncertain. We retrospectively reviewed patients aged ≥ 60 years who underwent noncardiac surgery lasting ≥ 1 h and were hospitalized for more than 2 days after surgery between January 2011 and June 2019. The ketorolac group included patients who received intravenous ketorolac in the operating room or post-anesthesia care unit. The primary outcome was postoperative AKI, defined according to the Kidney Disease: Improving Global Outcomes criteria. Propensity score matching (PSM) at a 1:3 ratio was performed to adjust for confounders, and a logistic regression model was used to assess the association between ketorolac use and postoperative AKI. Among 27,106 patients, 2433 (9.0%) received ketorolac at a median dose of 30 mg. The incidence of AKI during the first 7 days post-operatively was 4.2% (1024/24,673) in the non-ketorolac group and 2.9% (71/2433) in the ketorolac group. Following 1:3 PSM, perioperative ketorolac use was not significantly associated with postoperative AKI (adjusted odds ratio = 0.83, 95% confidence interval: 0.63-1.07, P = 0.16). This finding was consistent in subgroup analyses by patient comorbidities and in sensitivity analyses. Perioperative ketorolac use, primarily as a single 30 mg intravenous dose, was not associated with postoperative AKI in elderly patients undergoing noncardiac surgery. This finding suggests that low-dose, short-term perioperative ketorolac is a viable option to relieve immediate postoperative pain in elderly surgical patients.