Intravenous ketorolac is associated with reduced mortality and morbidity after open abdominal aortic aneurysm repair

Abstract

Objectives The role of non-steroidal anti-inflammatory drugs in aortic aneurysm disease has been debated. Animal studies demonstrated that intrathecal ketorolac reduces the inflammatory response associated with aortic clamping. However, no human-subject study evaluated this association. Therefore, we sought to explore the effects of ketorolac use in open abdominal aortic aneurysm repair. Methods The Premier Healthcare Database (June 2009–March 2015) was inquired to capture patients who underwent open abdominal aortic aneurysm repair for non-ruptured abdominal aortic aneurysm, identified via International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Intravenous ketorolac was coded as any or none. Outcomes were in-hospital mortality, cardiac, respiratory, renal, neurological, and hemorrhagic complications. Multivariable logistic regression coarsened exact matching followed by conditional fixed-effect regression modeling were performed. Results A total of 6394 patients were identified (ketorolac: 806; 12.6%). Patients who received ketorolac were younger and less likely to have hypertension (76.1% vs. 79.3%), diabetes mellitus (12.5% vs. 17.4%), or chronic kidney disease (8.3% vs. 21.4%; all p values ≤ .033). There was no significant difference in medication use including oral non-steroidal anti-inflammatory drugs and malignant or musculoskeletal diseases. Mortality, respiratory, and renal complications were less prevalent with ketorolac (2.5% vs. 4.9%, 25.2% vs. 34.6%, 10.0% vs. 21.1%; p ≤ .002). Ketorolac was associated with lower adjusted odds for those events: 0.58 (0.36–0.93), 0.53 (0.42–0.68), and 0.72 (0.60–0.86), respectively (all p values ≤ .025). There was no association with neurological, cardiac, or hemorrhagic complications. The findings were replicated by coarsened exact matching analysis. Conclusion This study demonstrated 40% mortality reduction with intravenous ketorolac following open abdominal aortic aneurysm repair. The survival benefit could be due to its anti-inflammatory and opioid-sparing properties. This is evident by its protective effect against respiratory outcomes. The lack of association with the classical non-steroidal anti-inflammatory drugs-related cardiac and hemorrhagic complication could be attributable to the short-term use of ketorolac compared with non-steroidal anti-inflammatory drugs chronic use.

Safety and efficacy of ketorolac in improving the prognosis of acute type A aortic dissection patients: a protocol of a randomized, double-blinded, and placebo-controlled study

“…There is also no clear literature support provided. Previous clinical studies have shown that ketorolac is safe for perioperative treatment of surgery [19] , and it has also been found to be bene cial in the treatment of aTAAD [15] . Our preliminary basic experiments have con rmed the bene cial effects of ketorolac on animal aortic aneurysms, which align with the conclusions of published basic research papers [12,20,21] .…”

“…Previous clinical research has suggested that ketorolac may reduce postoperative mortality, neurological complications, renal complications, and respiratory failure in patients undergoing open abdominal aortic aneurysm replacement surgery [15] . However, it is important to note that this study was retrospective and focused speci cally on abdominal aortic aneurysm.…”

Safety and efficacy of ketorolac in improving the prognosis of acute type A aortic dissection patients: a protocol of a randomized, double-blinded, and placebo-controlled study

“…There is also no clear literature support provided. Previous clinical studies have shown that ketorolac is safe for perioperative treatment of surgery [ 26 ], and it has also been found to be beneficial in the treatment of aTAAD [ 15 ]. Our preliminary basic experiments have confirmed the beneficial effects of ketorolac on animal aortic aneurysms, which align with the conclusions of published basic research papers [ 12 , 27 , 28 ].…”

“…Previous clinical research has suggested that ketorolac may reduce postoperative mortality, neurological complications, renal complications, and respiratory failure in patients undergoing open abdominal aortic aneurysm replacement surgery [ 15 ]. However, it is important to note that this study was retrospective and focused specifically on abdominal aortic aneurysm.…”