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Comparison between ketorolac- and fentanyl-based patient-controlled analgesia for acute kidney injury after robot-assisted radical prostatectomy: a retrospective propensity score-matched analysis

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Abstract

Purpose

It is unclear whether ketorolac-based patient-controlled analgesia (PCA) leads to acute kidney injury (AKI) after robot-assisted radical prostatectomy (RARP) in patients susceptible to AKI. We compared the postoperative AKI incidence with ketorolac- and fentanyl-based PCA after RARP.

Methods

After medical record review, eligible patients were divided in ketorolac and fentanyl groups. We conducted propensity score matching of 3239 patients and assigned 641 matched patients to each group, and compared the AKI incidence. We investigated potential risk factors for postoperative AKI, defined according to the Kidney Disease Improving Global Outcomes criteria. We collected preoperative data (age, height, weight, body mass index, American Society of Anesthesiologists physical status, medical history, creatinine level, estimated glomerular filtration rate, and hemoglobin level) and intraoperative data (maintenance anesthetics, surgery duration, anesthesia duration, crystalloid amount, colloid use, total amount of fluid administered, estimated blood loss, norepinephrine use, phenylephrine use, and PCA type).

Results

The postoperative AKI incidence was significantly higher in the ketorolac than in the fentanyl group, both before (31.1% vs. 20.4%; p < 0.001) and after (31.5% vs. 22.6%; p < 0.001) matching. In the univariate analysis, ketorolac was significantly associated with postoperative AKI, both before (odds ratio [OR], 1.762; 95% confidence interval [CI], 1.475–2.105; p < 0.001) and after (OR, 1.574; 95% CI, 1.227–2.019; p < 0.001) matching. In the multivariate analysis, ketorolac-based PCA was independently associated with development of postoperative AKI in the matched groups (OR, 1.659; 95% CI, 1.283–2.147; p < 0.001).

Conclusion

Ketorolac-based PCA may increase postoperative AKI incidence after RARP; thus, renal function should be monitored in these patients.

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Data availability

The data that collected and analyzed will be shared upon reasonable request to the corresponding author.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Dong Hyuck Kim

    Present address: Department of Anesthesiology and Pain Medicine, Daegu Catholic University School of Medicine, Daegu, Korea

  2. Dong Hyuck Kim and Young-Tae Jeon equally contributed to this work as co-first authors.

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Dong Hyuck Kim, Young-Tae Jeon, Hyung Geun Kim, Ah-Young Oh, Jung-Hee Ryu, Yu Kyung Bae & Chang-Hoon Koo

  2. Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea

    Young-Tae Jeon, Ah-Young Oh, Jung-Hee Ryu & Chang-Hoon Koo

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  1. Dong Hyuck Kim
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Contributions

DHK: Data collection, Data analysis, Manuscript writing. Y-TJ: study design, Data analysis, Manuscript editing. HGK: Data collection, Manuscript writing. A-YO: Data analysis, Manuscript editing. J-HR: Data analysis, Manuscript editing. YKB: Data collection, Manuscript writing. C-HK: Study design, Data analysis, Manuscript writing, Supervision. All authors read and approved the final version of the manuscript.

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Correspondence to Chang-Hoon Koo.

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Kim, D.H., Jeon, YT., Kim, H.G. et al. Comparison between ketorolac- and fentanyl-based patient-controlled analgesia for acute kidney injury after robot-assisted radical prostatectomy: a retrospective propensity score-matched analysis. World J Urol 41, 1437–1444 (2023). https://doi.org/10.1007/s00345-023-04374-3

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