Ketorolac Use After Head and Neck Free Tissue Transfer Is Not Associated With Increased Flap Complications

Area of Science:

• Oncology
• Surgical Innovation
• Pharmacology

Background:

• Head and neck cancer patients undergoing free-flap surgery face risks of bleeding complications.
• Evaluating the safety of ketorolac, a non-steroidal anti-inflammatory drug (NSAID), is crucial for pain management in this population.

Purpose of the Study:

• To assess the incidence of bleeding complications in head and neck cancer patients.
• To evaluate the safety of ketorolac administration within 5 days of free-flap surgery.

Main Methods:

• Retrospective cohort study of 4560 head and neck cancer patients undergoing free-flap surgery.
• Comparison of outcomes between patients who received ketorolac (n=2280) and those who did not (n=2280).
• Analysis of postoperative hemorrhage, flap revisions, blood vessel repair, acute kidney injury (AKI), and gastrostomy tube (G-tube) placement.

Main Results:

• Ketorolac use was not associated with an increased risk of postoperative hemorrhage (RR: 0.825, p=0.016).
• No increased risk observed for flap revisions (RR: 0.767), blood vessel repair (RR: 0.528), AKI (RR: 0.664), or G-tube placement (RR: 0.884).
• Statistical significance was achieved for all assessed outcomes (p < 0.05).

Conclusions:

• Postoperative ketorolac administration is safe in head and neck cancer patients undergoing free-flap surgery.
• No significant increase in complications, including bleeding, was observed within the 30-day postoperative period.
• Ketorolac can be considered a safe option for pain management in this patient cohort.