What is the clinical evidence from this study?

Study design: Cohort. Population: Non-cardiac surgery (n=45062). Intervention: Flurbiprofen axetil vs. Non-use. Primary outcome: Acute kidney injury (AKI) within 7 days after surgery (OR 0.61, 95% CI 0.51-0.73, p=<0.001).

What question did this study set out to answer?

This study evaluates how different timing of flurbiprofen axetil administration impacts acute kidney injury and other adverse events after non-cardiac surgery.

April 25, 2026Open Access

Perioperative Flurbiprofen Axetil Administration and Acute Kidney Injury After Non-Cardiac Surgery: A Retrospective Cohort Study

Q: What are the key findings of this study?

Flurbiprofen axetil administration during both intraoperative and postoperative periods significantly reduced the odds of acute kidney injury by 39% (OR 0.61) compared to non-use in patients undergoing non-cardiac surgery.

Q: What question did this study set out to answer?

This study evaluates how different timing of flurbiprofen axetil administration impacts acute kidney injury and other adverse events after non-cardiac surgery.

Key Result

Flurbiprofen axetil administration during both intraoperative and postoperative periods significantly reduced the odds of acute kidney injury by 39% (OR 0.61) compared to non-use in patients undergoing non-cardiac surgery.

Key Points

This study evaluates how different timing of flurbiprofen axetil administration impacts acute kidney injury and other adverse events after non-cardiac surgery.
Retrospective cohort study of 45,062 adult patients undergoing non-cardiac surgery from January 2019 to October 2023.
Analysis of perioperative flurbiprofen axetil administration and its timing based on electronic medical records.
Key outcomes assessed include acute kidney injury, adverse cardiovascular events, length of stay, and in-hospital mortality.
The incidence of acute kidney injury was 6.0% (2,683/45,062).
Intraoperative and postoperative administration of flurbiprofen axetil reduced odds of AKI (OR, 0.71 and OR, 0.73, respectively).
Postoperative flurbiprofen axetil was related to lower adverse cardiovascular events in the absence of preoperative hypertension (OR, 0.85).

Study Design

Type

Cohort (n=45,062)

Multicenter

Structured PICO

Does perioperative flurbiprofen axetil administration reduce acute kidney injury in adult patients undergoing non-cardiac surgery?

Population

45,062 adult patients undergoing non-cardiac surgery, mean age 52, 48.1% female, single-center in China. Exclusions: missed serum creatinine measurements before or after surgery within 7 days, age under 18 years, transplant surgery, end-stage renal disease (eGFR <15 mL/min/1.73m2 or history of renal replacement therapy), and ASA physical status V or VI.

Intervention

Perioperative flurbiprofen axetil (FA) administration (intraoperative intravenous infusion or postoperative patient-controlled analgesia).

Comparator

Non-use of flurbiprofen axetil.

Outcome

Acute kidney injury (AKI) within the first 7 postoperative days (defined by KDIGO criteria).hard clinical

Perioperative flurbiprofen axetil administration is associated with a reduced risk of postoperative acute kidney injury and shorter length of stay in patients undergoing non-cardiac surgery.

Main Result

Effect estimate: OR 0.61 (95% CI 0.51-0.73)

Absolute Event Rate: 3.5% vs 8.2%

p-value: p=<0.001

Limitations

Postoperative AKI was defined exclusively based on changes in serum creatinine measurement due to the absence of postoperative urine output data
Lack of postoperative inflammatory cytokines data limited direct exploration of the drug's anti-inflammatory mechanism on renal protection
Lacked systematic assessment of postoperative pain, precluding direct verification of the causal pathway linking analgesia to postoperative outcomes
Small number of mortality events precluded multivariate logistic regression analysis
Single-center retrospective cohort design limits the generalization of the conclusion and causal inference

Abstract

Purpose: This study aims to evaluate the impact of different timing of flurbiprofen axetil (FA) administration on postoperative acute kidney injury (AKI) and other adverse events in non-cardiac surgery patients. Patients and Methods: This retrospective cohort study included 45,062 adult patients undergoing non-cardiac surgery from January 1, 2019, to October 31, 2023. Perioperative FA analgesia records were extracted from electronic medical records. The primary outcome was AKI within 7 days after surgery. Secondary outcomes included postoperative adverse cardiovascular events (ACE), postoperative length of stay (LOS), and in-hospital mortality. Results: The incidences of AKI, ACE, and mortality were 6.0% (2,683/45,062), 8.5% (3,809/45,062), and 0.1% (48/45,062), respectively. Intraoperative odds ratio (OR), 0.71; 95% confidence interval (CI), 0.62– 0.82 and postoperative (OR, 0.73; 95% CI, 0.66– 0.79) FA administration was associated with lower odds of AKI compared with non-use. Compared to patients who did not receive FA analgesia at any point, those who received FA both during and post-surgery had a significantly lower odds of AKI (OR, 0.61; 95% CI, 0.51– 0.73). Subgroup analysis indicated a greater reduction in AKI odds for intraoperative FA administration in patients with a high inflammatory status (OR and 95% CI: 0.58 0.47– 0.72 vs 0.84 0.59– 1.20, P for interaction = 0.010). Postoperative, but not intraoperative FA administration, was associated with a lower odds of ACE (OR, 0.85; 95% CI, 0.79– 0.91), with this association was significant in patients without preoperative hypertension (OR and 95% CI: 0.81 0.74– 0.88 vs 0.96 0.81– 1.13, P for interaction< 0.05). Accelerated failure time model showed that both intraoperative and postoperative FA use was inversely correlated with postoperative LOS. Conclusion: Perioperative FA analgesia was associated with a lower odds of postoperative AKI and shorter postoperative LOS, whereas only postoperative FA analgesia was linked to a lower odds of postoperative ACE. Keywords: flurbiprofen axetil, acute kidney injury, adverse cardiovascular events, perioperative analgesia, postoperative complications

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Cite This Study

Wang et al. (Wed,) conducted a cohort in Non-cardiac surgery (n=45,062). Flurbiprofen axetil vs. Non-use was evaluated on Acute kidney injury (AKI) within 7 days after surgery (OR 0.61, 95% CI 0.51-0.73, p=<0.001). Flurbiprofen axetil administration during both intraoperative and postoperative periods significantly reduced the odds of acute kidney injury by 39% (OR 0.61) compared to non-use in patients undergoing non-cardiac surgery.

synapsesocial.com/papers/69ec5ae988ba6daa22dac65a https://doi.org/https://doi.org/10.2147/dddt.s597928

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