Intravenous ketorolac is associated with reduced mortality and morbidity after open abdominal aortic aneurysm repair. (February 2021)

• Record Type: Journal Article
• Authors: Nejim, Besma; Weaver, M Libby; Locham, Satinderjit; Al-Nouri, Omar; Naazie, Isaac N; Malas, Mahmoud B
• Is Part Of: Vascular. Volume 29:Number 1(2021)
• Page Start: 15
• Page End: 26
• Publication Date: 2021-02
• Subjects: Abdominal aortic aneurysm -- endovascular repair -- ketorolac -- non-steroidal anti-inflammatory drugs -- open repair; 616.13
• DOI: 10.1177/1708538120914454
• Languages: English
• ISSNs: 1708-5381

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.