Increased postoperative complications found with ketorolac

Last Updated: 2015-07-08

By Will Boggs MD

NEW YORK (Reuters Health) - The use of ketorolac for analgesia in gastrointestinal surgery is associated with an increased risk of postoperative complications, researchers report.

"Until a definitive study - in the form of a randomized controlled trial, which our group in Washington is beginning - has been completed, we should exercise caution in the use of NSAIDs, such as ketorolac, in patients with staple lines and anastomoses," Dr. Meera Kotagal from the University of Washington in Seattle told Reuters Health by email.

Recent reports from five observational studies have suggested that NSAIDs could impair anastomotic healing, Dr. Kotagal and colleagues note in Annals of Surgery, online June 23.

To further investigate this possibility, the team used the Truven Health MarketScan Commercial Claims Database to assess whether ketorolac use is associated with higher rates of reinterventions, emergency department visits, and readmissions within 30 days of undergoing gastrointestinal surgery. The retrospective study included nearly 19,800 patients who received ketorolac and 379,000 who did not.

Patients who got the drug had significantly higher rates of emergency department visits (11.4% vs. 7.5%), readmissions (8.0% vs. 7.3%), and reinterventions (2.3% versus 2.0%) within 30 days of surgery, the researchers found.

After controlling for a number of factors, ketorolac was associated with 44% higher odds of an emergency department visit, 11% higher odds of readmission, and 20% higher odds of reintervention, compared with no ketorolac use.

"As the limitations of the study address, there is the potential for confounding by indication, in that patients that have more pain due to complications may receive ketorolac as a result," Dr. Kotagal explained. "We try to address this with our methodology, but the potential for residual confounding exists, as in any observational study."

"This is not a definitive finding, but rather an association that should raise flags given that it supports previous research in this arena," Dr. Kotagal said.

SOURCE: http://bit.ly/1RksPo5

Ann Surg 2015.