Safety Of Routine Post-operative Ketorolac Use In Patients Undergoing Microsurgical Breast Reconstruction
Cameron J. Kneib, BS1, Hyeyoun Elise Min, MD1, Suzette G. Miranda, MD2, David W. Mathes, MD3, Alexander J. Gougoutas, MD1.
1Division of Plastic Surgery, University of Washington, Seattle, WA, USA, 2Swedish Medical Center, Seattle, WA, USA, 3Division of Plastic Surgery, University of Colorado, Denver, CO, USA.
PURPOSE: Ketorolac's inhibition of platelet aggregation may reduce thrombosis in microsurgial reconstruction. Acute bleeding and renal failure (ARF), however, may complicate its routine usage. To date, the safety of ketorolac in patients undergoing microsurgical breast reconstruction has not been demonstrated, and thus represents the aim of this study.
METHODS: A single institution, retrospective review of patients undergoing DIEP/MS-TRAM breast reconstruction between July, 2013 - August, 2016 was performed. Patients with pre-existing renal insufficiency, those undergoing concurrent gynecologic procedures or vascularized lymph node transfers, and those administered intraoperative thrombolytic agents, ketorolac, or heparin were excluded. All patients received thromboprophylaxis for 48 hours post-operatively. Prior to 2015, patients received SQ heparin only, while those after 2014 received both SQ heparin and 15mg intravenous ketorolac q6hrs. Patient demographics, operative details, rates of acute, post-operative complications requiring takeback (abdominal/breast hematoma, vascular compromise), rates of flap loss, and ARF were assessed. RESULTS: Of 180 total patients (290 flaps), 92 received ketorolac (144 flaps) while 88 did not (146 flaps). The groups did not differ significantly in age, BMI, smoking status, flap type, operative time, or medical comorbidities. No differences in rates of post-operative complications requiring takeback or flap loss were detected between the groups (Figure 1). No patients developed ARF. CONCLUSION: Use of post-operative ketorolac in microsurgical breast reconstruction is safe and does not increase post-operative complication rates or ARF.
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