Abstract: FR-PO0067
Perioperative Ketorolac Administration and AKI
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Kaunfer, Sarah Allison, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Durai, Lavanya, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Dias, Julie-Alexia, Harvard University, Cambridge, Massachusetts, United States
- Sanchez Almanzar, Daniel, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Schaefer, Maximilian S., Beth Israel Deaconess Medical Center Department of Anesthesia Critical Care and Pain Medicine, Boston, Massachusetts, United States
- Shaefi, Shahzad, Beth Israel Deaconess Medical Center Department of Anesthesia Critical Care and Pain Medicine, Boston, Massachusetts, United States
- Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
Ketorolac is a potent nonsteroidal anti-inflammatory drug (NSAID) often used for postoperative pain following cardiac surgery. However, limited data are available on its kidney safety profile in this population, where the baseline risk of AKI is already high.
Methods
We performed a multicenter cohort study among consecutive adults who underwent cardiac surgery at three major hospitals in Boston between 2015 and 2022. We used a sequential target trial emulation (TTE) framework to examine outcomes in patients who initiated treatment with ketorolac within the first 5 days following cardiac surgery vs. those who did not (Figure 1A). We focused on treatment within the first 5 days, as this window accounted for 97.3% of all NSAIDs initiated in the first week postoperatively (Figure 1B). We focused on ketorolac, as it constituted 96.5% of all NSAIDs initiated during that time (Figure 1C). The primary outcome was AKI (increase in SCr ≥50% or KRT initiation) within 3 days following treatment assignment. We used multivariable logistic regression to adjust for confounders.
Results
Among 26,309 patients eligible for inclusion, 4584 (17.4%) received ketorolac and 854 (3.2%) developed AKI within 3 days following treatment assignment. The median daily cumulative dose of ketorolac was 30 mg (IQR, 30-60). In the primary analysis, patients who received ketorolac had a similar risk of AKI compared to those who did not (adjusted odds ratio 0.95 [95% CI, 0.76–1.18) (Figure 1D).
Conclusion
In this multicenter cohort study of adult cardiac surgical patients, the risk of AKI was similar in those who received ketorolac postoperatively compared to those who did not.