Reduced Dose Perioperative Non-Steroidal Anti-Inflammatory Drugs in Arthroplasty Patients With Renal Impairment: A Five-Year Cohort Study

ABSTRACTBackgroundNon‐steroidal anti‐inflammatory drugs (NSAIDs) are fundamental for multimodal analgesic therapy, but are traditionally avoided in renally impaired patients. We aim to show NSAIDs can be safely administered to arthroplasty patients with a pre‐operative estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 without causing a permanent reduction in post‐operative eGFR and, in doing so, minimise opioid use.MethodsWe prospectively collected data from patients with a pre‐operative eGFR less than 60 mL/min/1.73 m2 undergoing arthroplasty between January 2018 and June 2023 at St John of God Ballarat Hospital, Australia. Baseline eGFR was obtained pre‐operatively, and on at least 1 of days 1, 2, 10, or a follow‐up review appointment of at least 4 weeks. Patients received tailored dosing of perioperative NSAIDs corresponding to pre‐operative eGFR. Acute kidney injury (AKI) was defined using the RIFLE criteria.ResultsWe identified 221 patients. Median baseline eGFR was 50 mL/min/1.73 m2 and median eGFR recovery at latest follow‐up was 109% of baseline eGFR. 28% of the cohort had a clinically significant reduction in eGFR on day 1 post‐operatively, and by latest follow‐up, this subgroup had a median recovery of 106% of baseline eGFR. At the 2‐week follow‐up, there were no cases of AKI, and by latest follow‐up, no patients had a clinically significant reduction of baseline eGFR.ConclusionPerioperative NSAIDs in renally impaired patients undergoing arthroplasty surgery can be safely given using an adjusted dose protocol based on pre‐operative renal function. Future studies investigating the circumspect use of NSAIDs for pain management during arthroplasty are warranted.