Ketorolac use following operative clavicle fracture fixation is not associated with increased nonunion or surgical complications: A propensity-matched analysis

Abstract

Objectives

: Nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are commonly used for postoperative pain management. Concerns about their potential impact on bone healing have been raised. This study investigated the relationship between ketorolac use and postoperative complications following clavicle surgery, including nonunion rates.

Methods

This retrospective cohort study used the TriNetX Research Database to identify patients who underwent surgical fixation of clavicle fractures between 2002 and 2022. Two propensity-matched cohorts were created: patients who received postoperative ketorolac and those who did not. Primary outcomes included nonunion diagnosis and revision surgery; secondary outcomes included opioid use, wound disruption, surgical site infection, and infected hardware at 30 days, 90 days, 1 year, and 2 years postoperatively.

Results

: 5,264 patients were in each cohort after matching. Nonunion diagnosis was similar between the ketorolac and no-ketorolac groups at 30 days (16 vs. 18, P=0.731), 90 days (31 vs. 40, P=0.284), 1 year (93 vs. 88, P=0.708), and 2 years (104 vs. 100, P=0.777). Similarly, revision surgery for nonunion was comparable between the two groups at all time points, 30 days (<10 vs <10, P=1), 90 days (<10 vs <10, P=1), 1 year (24 vs. 20, P=0.546), and 2 years (27 vs 26, P=0.890). Opioid prescription rates were comparable across all time points but trended lower in the ketorolac group: 30 days (1,827 vs. 1,906, P=0.108), 90 days (1,967 vs. 2,051, P=0.092), 1 year (2,340 vs. 2,428, P=0.085), and 2 year (2,574 vs 2,642, P=0.185).

Conclusion

: Ketorolac use following clavicle surgery was not associated with increased nonunion or revision surgery rates. Although opioid prescription rates trended lower in the ketorolac group, the difference was not statistically significant.