Summary of findings for the main comparison. Nonsteroidal anti‐inflammatory drugs (NSAIDs) versus placebo or no treatment in the peri‐operative period.
| NSAIDs versus placebo or no treatment in the peri‐operative period | ||||||
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Patient or population: adults with normal kidney function undergoing surgery Settings: hospitals, mainly high‐income countries (North America or Western Europe) Intervention: administration of NSAIDs in the peri‐operative period Comparison: placebo or no treatment | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo | Intervention (NSAID) | |||||
| AKI within 30 days of surgery | 12 per 100 | 13 per 100 (12 to 14) | RR 1.79 (0.40 to 7.96) | 7066 (2) | ⊕⊝⊝⊝ very low1 | NAFARM 2011 was stopped by study monitoring committee because of increased risk of AKI. Both studies used NSAID doses that were much lower than would be used for analgesia in usual care. The results raise serious concerns about the safety of post‐operative analgesia with NSAIDs in unselected patients |
| SCr increase within 30 days of surgery | The mean difference in SCr in control group was decreased by ‐2.60 µmol/L | The mean difference in SCr in the intervention group was increased by 1.52 µmol/L (‐7.4 to 10.2) | Difference in post‐operative SCr increased by 3.23 µmol/L (‐0.8 to 7.26) | 794 (15) | ⊕⊕⊝⊝ low2 | Heterogeneity was not explained by pre‐specified effect modifiers (Table 2, Figure 1) |
| RRT within 30 days of surgery | 2 per 1000 | 5 per 1000 (2 to 11) | RR 1.57 (0.49 to 5.07) | 7056 (2) | ⊕⊝⊝⊝ very low3 | ‐‐ |
| Death (all causes) | 2 per 100 |
3 per 100 (0 to 6) |
RR 1.44 (0.19 to 11.12) | 312 (2) | ⊕⊝⊝⊝ very low3 | ‐‐ |
| Length of hospital stay | The mean length of hospital stay in control group was 10.0 days | The mean length of hospital stay in the intervention group was 10.6 days (range 5.3 to 18.33) | MD 0.12 (‐0.48 to 0.72) | 410 (3) | ⊕⊝⊝⊝ very low3 | ‐‐ |
| *The basis for the assumed risk is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio; MD: mean difference; AKI: acute kidney injury; SCr: serum creatinine; RRT: renal replacement therapy | ||||||
| GRADE Working Group grades of evidence High certainty: Further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: We are very uncertain about the estimate. | ||||||
The assumed risk is the median or mean across the control groups for each intervention
1 1 downgrade for study limitations, one for imprecision, and one for heterogeneity (Appendix 3).
2 We downgraded the certainty of evidence to low because of inconsistency and indirectness (Appendix 3).
3 We downgraded the certainty of evidence to very low because of risk of bias, imprecision, inconsistency and indirectness (Appendix 3).