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The Impact of Intraoperative Ketorolac on Postoperative Complications Following Distal Radius ORIF: A Propensity-Matched Analysis
Katherine Ferry, MD
1, Jad Lawand, MS
1, Umar M. Ghilzai, MD
2, Sameer R. Khawaja, MD
2, Jeffrey Hauck, BS
2; John Faillace, MD
1(1)University of Texas Medical Branch, Galveston, TX, (2)Baylor College of Medicine, Houston, TX
Introduction: Intraoperative ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is commonly used for pain management, but its impact on postoperative outcomes following distal radius open reduction and internal fixation (ORIF) remains unclear. This study examines the association between intraoperative ketorolac and short- and long-term complications, including its potential to reduce postoperative pain.
Methods: A retrospective cohort study using electronic medical records compared patients who received intraoperative ketorolac to those who did not. Propensity score matching (1:1) adjusted for demographic and comorbidity differences. Primary outcomes included 90-day complications (e.g., infection, DVT, sepsis, wound disruption, and complex regional pain syndrome [CRPS]). Secondary outcomes assessed two-year complications (e.g., mechanical fixation failure, nonunion, malunion, and tendon rupture). Opioid prescribing patterns within three months were also analyzed. Risk ratios (RR) and 95% confidence intervals (CI) compared outcomes.
Results: After matching, 5,607 patients remained in each group. The ketorolac cohort had lower opioid prescription rates (40.81% vs. 45.23%, RR=0.902, p=0.0042) and fewer opioid prescriptions per patient (3.09 ± 4.86 vs. 3.99 ± 5.81, p=0.0005). No significant differences were observed in infection, DVT, wound disruption, or CRPS rates. Ketorolac use was associated with lower rates of mechanical fixation failure (0.7% vs. 1.2%, p=0.038) and nonunion (0.4% vs. 1.1%, p=0.001).
Conclusions: Intraoperative ketorolac is associated with reduced opioid use, lower mechanical fixation failure, and fewer nonunions. These findings suggest that intraoperative intravenous ketorolac may enhance pain management without increasing postoperative complications and may even offer benefits to bone healing in adult patients undergoing ORIF of the distal radius.
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