Postoperative Ketorolac in Breast and Body Contouring Procedures: A Nationwide Claims Analysis.

Abstract

BACKGROUND:

Nonsteroidal antiinflammatory drugs are useful alternatives to narcotics for analgesia. However, concerns remain regarding their safety. The authors evaluated ketorolac use and complications. We hypothesized that no association between ketorolac and morbidity exists in patients undergoing body contouring.

METHODS:

Truven MarketScan claims database was analyzed for patients undergoing breast and body contouring surgery. Patients selected received ketorolac and were enrolled a minimum of 90 days. The authors performed a multivariable logistic regression to calculate risk of morbidity, adjusting for clinical and sociodemographic factors.

RESULTS:

Among the 106,279 patients enrolled, 4924 (4.6 percent) received postoperative ketorolac. In multivariable regression analysis, ketorolac was not associated with hematoma (OR, 1.20; 95 percent CI, 0.99 to 1.46; p > 0.05). There was an increased rate of reoperation within 72 hours (OR, 1.22; 95 percent CI, 1.00 to 1.49; p < 0.05; number needed to harm, 262 patients). Ketorolac was associated with fewer readmissions (OR, 0.76; 95 percent CI, 0.62 to 0.93; p < 0.05; number needed to treat, 87 patients), with a reduction in the rate of pain as a readmission diagnosis (0.6 percent versus 4.3 percent; p = 0.021). Ketorolac was associated with seroma, but this association may not be causal (OR, 1.28; 95 percent CI, 1.05 to 1.57; p < 0.05; number needed to harm, 247 patients). Ketorolac provided an estimated savings of $157 per patient.

CONCLUSIONS:

The benefits of ketorolac likely outweigh the risks after surgery. Absolute differences in reoperation rates were low, and improved rates of hospital admission impact cost savings. The authors advocate postoperative ketorolac once the wound is hemostatic.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.

• Authors: Brian P Kelley, Kevin C Chung, Ting-Ting Chung, Katelyn G Bennett, Gina Sacks, Erika D Sears, Jennifer F Waljee
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 142 Issue 4 Pg. 472e-480e (10 2018) ISSN: 1529-4242 [Electronic] United States
• PMID: 30252810 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Ketorolac

Topics

• Adult
• Aged
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects, therapeutic use)
• Body Contouring (methods)
• Breast (surgery)
• Female
• Hematoma (chemically induced)
• Humans
• Ketorolac (adverse effects, therapeutic use)
• Male
• Middle Aged
• Pain Management (adverse effects, methods)
• Pain, Postoperative (drug therapy)
• Patient Readmission (statistics & numerical data)
• Postoperative Complications (etiology)
• Regression Analysis
• Reoperation (statistics & numerical data)