Postoperative analgesia with ketorolac is associated with decreased mortality after isolated coronary artery bypass graft surgery in patients already receiving aspirin: a propensity-matched study.
OBJECTIVE
This study was designed to determine the effect of ketorolac on mortality after cardiac surgery.


METHODS
A retrospective multivariable analysis with propensity matching and propensity scoring.


METHODS
A tertiary care university-affiliated medical center.


METHODS
Eleven hundred eighty-six patients undergoing isolated coronary artery bypass surgery.


RESULTS
Between January 1, 2002, and November 1, 2004, 168 patients undergoing isolated coronary artery bypass surgery received ketorolac, whereas 1,018 patients did not. There were 2 deaths (1%) in the ketorolac group compared with 104 (10%) in the nonketorolac group (p < 0.001). Within 90 days of surgery, there was 1 death (1%) in the ketorolac group compared with 51 (5%) in the nonketorolac group (p = 0.01). By Cox modeling, ketorolac use was associated with a 7-fold lower risk of death (p = 0.02). In the patients who survived at least 90 days, there was 1 death (1%) in the ketorolac group compared with 53 (5%) in the nonketorolac group (p = 0.01). By Cox modeling, ketorolac use was associated with a 2.4-fold lower risk of death (p = 0.03) in the late hazard period. In the propensity-matched groups, Kaplan-Meier survival was better in patients who received ketorolac (p = 0.02).


CONCLUSIONS
The use of ketorolac was associated with a statistically significant decrease in mortality at follow-up.
Engoren
Milo C
MC
Department of Anesthesiology, Medical University of Ohio, Toledo, OH, USA. engoren@pol.net <engoren@pol.net>
Habib
Robert H
RH
Zacharias
Anoar
A
Dooner
John
J
Schwann
Thomas A
TA
Riordan
Christopher J
CJ
Durham
Samuel J
SJ
Shah
Aamir
A
D000284:Administration, Oral; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D020910:Ketorolac / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin; D020910:Ketorolac