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Perioperative Ketorolac Is Associated With Lower Mortality After Surgically Treated Hip Fracture in Older Adults
Stephen J Perle1, Nicholas C Bank, Joshua L Morningstar
1From the The University of North Carolina School of Medicine (Perle, Morningstar), Chapel Hill, NC, and the Department of Orthopaedics (Dr. Bank, Dr. Himmelberg, Dr. Orders, Dr. Chen), The University of North Carolina School of Medicine, Chapel Hill, NC.
Introduction:
Hip fractures in older adults are common and associated with substantial mortality. Effective analgesia is essential to mobilization and recovery, with opioid-sparing strategies prioritized in this vulnerable population. Perioperative ketorolac is widely used, but its impact on early postoperative outcomes and bone healing after hip fracture remains uncertain. We evaluated associations between perioperative ketorolac and 90-day mortality and medical complications, with secondary assessment of 2-year surgical complications, in adults ≥65 undergoing hip fracture repair.
Methods:
This retrospective cohort study used the multicenter TriNetX Research Network. Patients ≥65 years undergoing fixation or hemiarthroplasty for hip fracture were identified after exclusion of pathologic/open fractures, bilateral/multiple procedures, and absolute contraindications to ketorolac. Exposure was defined as receipt of intravenous ketorolac within 48 hours of surgery. A 48-hour postoperative landmark was applied, excluding patients who died before the landmark. Ketorolac and No-Ketorolac cohorts were 1:1 propensity matched by surgery type, demographics, and the Elixhauser Comorbidity Index. Primary outcomes were 90-day mortality and medical complications; secondary outcomes included 2-year surgical complications. Mortality was assessed using Kaplan-Meier survivorship modeling and hazard ratios (HRs); complications were compared with risk ratios (RRs) and 95% confidence intervals (Cis).
Results:
After matching, 11,450 patients were analyzed (5725 per cohort). Ninety-day mortality did not differ between the cohorts (3.7% vs 4.1%; HR 0.885, 95% CI, 0.735 to 1.066); 90-day medical complications were largely similar, with a lower incidence of acute renal failure in the ketorolac cohort (RR 0.775, 0.615 to 0.977). At 2 years, surgical complication rates were low and did not differ markedly between the groups.
Discussion:
Intravenous ketorolac administered within a 48-hour perioperative window was not associated with increased 90-day mortality or medical complications in older adults undergoing hip fracture surgery. These findings support the safety of perioperative ketorolac within multimodal analgesic strategies, although further prospective study is warranted to better define patient selection and longer term outcomes.