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

Kelley, Brian P., M.D.; Chung, Kevin C., M.D., M.S.; Chung, Ting-Ting, M.S.; Bennett, Katelyn G., M.D.; Sacks, Gina, M.D.; Sears, Erika D., M.D., M.S.; Waljee, Jennifer F., M.D., M.S.

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 472e-480e
doi: 10.1097/PRS.0000000000004806
Cosmetic: Original Articles
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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.

Ann Arbor, Mich.

From the Section of Plastic Surgery, University of Michigan; and the Veterans Affairs Center for Clinical Management Research.

Received for publication December 17, 2017; accepted April 18, 2018.

Disclosure:None of the authors has a financial interest in any of the products, devices, or companies mentioned in this article.

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Brian P. Kelley, M.D., Section of Plastic Surgery, University of Michigan Health System, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, Mich. 48109-5340, kelleybr@med.umich.edu

Copyright © 2018 by the American Society of Plastic Surgeons