Postoperative Ketorolac Administration and Pseudoarthrosis Following Lumbar Spinal Fusion: A Matched Cohort Study

Retrospective cohort study.

To evaluate opioid utilization and pseudoarthrosis risk following lumbar spinal fusion in patients receiving postoperative ketorolac versus those who did not.

Ketorolac is increasingly used in multimodal pain regimens to reduce opioid use. However, its effect on bone healing, particularly after lumbar fusion, remains unclear.

Using the TriNetX database, we identified patients undergoing lumbar spinal fusion with ≥30 days of follow-up, excluding those with prior pseudoarthrosis. Patients were grouped by postoperative ketorolac use and matched 1:1 by sex, age, ethnicity, and comorbidities. Primary outcomes included opioid prescriptions at 7, 14, and 30 days. Pseudoarthrosis was assessed at one and two years. Secondary outcomes included bowel regimen use, ileus, DVT, PE, AKI, transfusion, infection, wound disruption, lab values (Hgb, Hct, Cr), readmissions, ED visits, and mechanical complications at one and two years.

After matching, 15,260 patients were included in each group. Ketorolac use was associated with fewer opioid prescriptions at all short-term timepoints ( e.g. 2.5 vs. 2.8 at 7 d, P <0.001) and less bowel regimen use ( P <0.001). DVT, PE, and ileus risk were lower in the ketorolac group ( P <0.05). No increase in AKI, Cr, or transfusion rates was observed. At one and two years, ketorolac users had reduced mechanical complications and comparable pseudoarthrosis rates.

Postoperative ketorolac may reduce short-term opioid use and thromboembolic risk without increasing pseudoarthrosis or mechanical complications. These findings support ketorolac as a potentially safe adjunct in postoperative pain management. Further randomized trials are warranted.