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Intraoperative Ketorolac is Associated with Risk of Reoperation After Mastectomy: A Single-Center Examination
Patrick J McCormick1,2, Melissa Assel3, Kimberly J Van Zee4,5
1Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. mccormp1@mskcc.org.
Annals of Surgical Oncology
|February 25, 2021
Summary
Ketorolac use in mastectomy patients increased bleeding reoperation risk, despite reducing opioid needs. This finding led to a practice change, with ketorolac no longer used perioperatively.
Area of Science:
- Oncology
- Anesthesiology
- Pharmacology
Background:
- Ketorolac is an effective perioperative pain management drug.
- However, ketorolac use is linked to an increased risk of postoperative bleeding.
Purpose of the Study:
- To investigate the association between ketorolac use and reoperation for bleeding.
- To assess the impact of ketorolac on postoperative opioid consumption in mastectomy patients.
Main Methods:
- Retrospective study of 3469 women undergoing mastectomy from January 2016 to June 2019.
- Primary outcome: reoperation for bleeding (postoperative day 0 or 1).
- Secondary outcome: postoperative opioid use. Multivariable regression analysis was used.
Main Results:
- Ketorolac was administered to 45% of patients.
- Ketorolac use was associated with a significantly higher risk of reoperation for bleeding (OR 2.43, P < 0.0001).
- Ketorolac use was associated with reduced postoperative opioid use (15 mg: OR 0.73, P = 0.014; 30 mg: OR 0.52, P < 0.0001).
Conclusions:
- The increased risk of bleeding requiring reoperation outweighed the benefit of reduced opioid use.
- Ketorolac is no longer administered in the perioperative care of mastectomy patients at the authors' institution.
