Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used as part of multimodal analgesia, but their association with acute kidney injury (AKI) in patients undergoing elective surgery remains uncertain. We conducted a retrospective, propensity score-matched study at a single-center academic hospital (ChiCTR2300076725). The primary outcome was the incidence of AKI, defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria, compared between patients who did and did not receive NSAIDs during surgery. Secondary outcomes included AKI severity staging and prolonged postoperative hospitalization (≥7 days). A total of 11,139 patients were included, with 3,361 in the NSAIDs group and 7,778 in the control group. After propensity score matching (PSM), 3,361 matched pairs were obtained. The incidence of postoperative AKI was comparable between the NSAIDs and control groups after matching (4.2% vs. 4.2%, p > 0.999). The distribution of AKI stages (p = 0.830) and the median duration of postoperative hospital stay were also comparable between the two groups (both 6 days, p = 0.290). Sequentially adjusted logistic regression models consistently showed no significant association between NSAIDs and AKI, AKI staging, or prolonged hospitalization, both before and after PSM. Stratified analyses by NSAID type and dose-response analyses revealed no significant association with AKI. A sensitivity analysis using complete cases without imputation (n = 9,385) yielded consistent results. In conclusion, intraoperative NSAIDs administration was not independently associated with an increased risk of postoperative AKI in patients undergoing major noncardiac surgery.
Keywords: Acute kidney injury; NSAIDs; major noncardiac surgery; propensity score matching.