We conducted a systematic review with meta‐analysis according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA)statements, the Cochrane Handbook, and the Grading of Recommendations Assessment, Development, and Evaluation(GRADE) methodology. We includedrandomised clinical trials (RCT) comparing postoperative treatment with furosemide vs.no furosemide in adult surgical patients. Risk ratios (RR) with 95% confidence intervals (CI) were estimated by conventional meta‐analysis and trial sequential analysis.
2567 records were identified and4 trials with 325 patients in total were included. All were adjudicated as having overall high risk of bias. We observed no statistically significant difference between furosemide vs. no furosemide treated patients in any of the predefined outcome measures, including acute kidney injury (AKI) (RR 1.07, 95% CI0.43‐2.65), all‐cause mortality (RR 1.73, 95% CI0.62‐4.80, use of vasopressors postoperatively (RR 1.04, 95% CI0.74‐1.44) or need for renal replacement therapy (RR 3.87, 95% CI0.44‐33.99). Trial sequential analysis highlighted sparse data, and the overall quality of evidence was very low.
In this systematic review, we found that the quantity and quality of evidence for using furosemide postoperatively in adult surgical patients was very low with no firm evidence for benefit or harm.