Abstract
Background
Although ketorolac is an effective adjunct for managing pain in the perioperative period, it is associated with a risk of postoperative bleeding. This study retrospectively investigated the association between ketorolac use and both reoperation and postoperative opioid use among mastectomy patients.
Methods
The study identified all women undergoing mastectomy (unilaterally or bilaterally) at our ambulatory surgery cancer center from January 2016 to June 2019. The primary outcome was reoperation for bleeding on postoperative day 0 or 1, and the secondary outcome was postoperative opioid use. The association between ketorolac and outcomes was assessed using multivariable regression models. The covariates were age, body mass index, breast reconstruction, bilateral surgery, peripheral nerve block, and preoperative antiplatelet and/or anticoagulation medication.
Results
A cohort of 3469 women were identified. Ketorolac was given to 1549 (45%) of the women, with 922 women (60%) receiving 30 mg and 627 women (40%) receiving 15 mg. The overall reoperation rate for bleeding was 3.1% (1.8% without ketorolac vs 4.8% with ketorolac). In the multivariable analysis, ketorolac was associated with a higher risk of reoperation [odds ratio (OR) 2.43; 95% confidence interval (CI) 1.60–3.70; P < 0.0001]. Ketorolac also was associated with a lower proportion of patients receiving any postoperative narcotic within 24 h (15 mg: OR 0.73; 95% CI 0.57–0.94; P = 0.014 vs 30 mg: OR 0.52; 95% CI 0.42–0.66; P < 0.0001).
Conclusions
Ketorolac use decreased postoperative opioid use, but this benefit was outweighed by the increased risk of bleeding requiring reoperation. This finding led to a change in practice at the authors’ center, with ketorolac no longer administered in the perioperative care of the mastectomy patient.
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Acknowledgment
This research was supported by the National Cancer Institute of the National Institutes of Health under Award No. P30CA008748. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Dr. McCormick's spouse holds stock in Johnson & Johnson. Monica Morrow has received honoraria from Roche and Genomic Health. The remaining authors have no conflicts of interest.
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McCormick, P.J., Assel, M., Van Zee, K.J. et al. Intraoperative Ketorolac is Associated with Risk of Reoperation After Mastectomy: A Single-Center Examination. Ann Surg Oncol 28, 5134–5140 (2021). https://doi.org/10.1245/s10434-021-09722-4
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DOI: https://doi.org/10.1245/s10434-021-09722-4