Ketorolac May Increase Hematoma Risk in Reduction Mammaplasty: A Case-control Study

Abstract

Background:Ketorolac is a potent nonsteroidal anti-inflammatory drug that has valuable analgesic properties but also a hypothetical risk of increased bleeding due to inhibition of platelet activation. The clinical significance of this risk, however, is unclear when it is used after reduction mammaplasty. Our study objective was to therefore examine the association between ketorolac exposure and hematoma occurrence after breast reduction surgery. We hypothesized that there was no association between ketorolac exposure and hematoma occurrence in breast reduction surgery.Methods:A case-control design was used. Data from charts of all reduction mammaplasties that developed hematomas requiring surgical evacuation (cases) at our university-based hospitals were retrieved and matched to data from charts of reduction mammaplasty patients who did not indicate this complication (controls). Matching occurred in a 1:1 ratio based on 4 criteria: age, body mass index, institution, and preexisting hypertension. Charts were reviewed for retrospective information on exposure to ketorolac. Odds ratio (OR) was calculated with an OR > 1 favoring an association.Results:From 2002 to 2016, 40 cases of hematoma met inclusion criteria and were matched with 40 controls (N = 80). Cases had a significantly lower body mass index than controls; however, the other baseline patient demographics were similar between the 2 groups. There was an association between hematoma formation and exposure to ketorolac (OR, 2.4; 95% confidence interval, 0.8–7.4; P = 0.114) and a trend for greater risk of hematoma formation, although this was not statistically significant.Conclusions:Based on this level 3 evidence, there appears to be an association between perioperative ketorolac exposure and hematoma after breast reduction surgery, but it was not statistically significant. Although this study was adequately powered, the OR of 2.4 was associated with a wide confidence interval. A larger sample size may increase the precision of the results and may also make the association definitive.

Scheduled Postoperative Ketorolac Does Not Decrease Opiate Use following Free Flap Breast Reconstruction

“…28 29 Barkho et al reported an increase in hematoma following reduction mammaplasty surgery and independent association with ketorolac use. 28 A retrospective analysis by Cawthorn et al also found that patients who received ketorolac had increased risk of hematoma. 29 In our study, hematoma rates were similar between ketorolac and nonketorolac groups, 5 (3 patients) and 3.6% (2 patients), respectively; there was no statistical significance ( p = 1.0).…”

“…27 Over the last decade, studies have reported an increased postoperative risk of hematoma with ketorolac use. 28,29 Barkho et al reported an increase in hematoma following reduction mammaplasty surgery and independent association with ketorolac use. 28 A retrospective analysis by Cawthorn et al also found that patients who received ketorolac had increased risk of hematoma.…”

Improving the Science in Plastic Surgery

“…39 In this case, the correct study design would be a case-control design. 40 Investigators should collaborate with a biostatistician when determining which study design best answers their research question.…”

American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty

“…Two studies 85,86 found only a slightly increased risk of hematoma associated with perioperative ketorolac that was nonsignificant in otherwise healthy patients. Two additional studies 87,88 showed a minimally increased risk of developing a hematoma after reduction mammaplasty in women who were administered perioperative ketorolac. Further research is needed before conclusions can be drawn about the risk-tobenefit comparison of ketorolac.…”