Ketorolac use may increase risk of postoperative pancreatic fistula after pancreaticoduodenectomy

Stacy J. Kowalsky, Mazen S. Zenati, Jennifer Steve, Kenneth K. Lee, Melissa E. Hogg, Herbert J. Zeh, Amer H. Zureikat

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Ketorolac (Toradol), a commonly used nonselective nonsteroidal anti-inflammatory drug (NSAID) in the postoperative period, has been associated with increased risk of anastomotic leak after colon resection. The effect of postoperative NSAID and ketorolac use on postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is unknown. Methods Retrospective review of consecutive PDs at a high-volume pancreas center from 2012 to 2015. POPF was identified and graded using International Study Group on Pancreatic Fistula criteria. Demographics, operative variables and 30-d postoperative NSAID use, dosage, and timing (early = postoperative day [POD] 0-5, late > POD 5) were collected. Univariate and multivariate logistic regressions were used to identify predictors of POPF. Results Four hundred twenty-three PDs were analyzed (mean age 66 y, 47% female), and 60% received NSAIDs postoperatively. Ketorolac (median POD 0-5 cumulative dose = 90 mg, interquartile range 60-165) was used in 35.7% (n = 151). POPF occurred in 90 patients (21.3%). Early (POD 0-5) ketorolac use was associated with increased POPF, especially grade A (odds ratio [OR] 2.16, P = 0.036). Each 25 mg incremental increase in ketorolac use was associated with a 10% increase in the incidence of POPF (OR 1.10, P = 0.021), whereas a cumulative dose of >150 mg was associated with a 44% increased risk of POPF (OR 1.44, 95% confidence interval 1.03-2.01, P = 0.035). A multivariate regression model identified estimated blood loss, soft gland, pancreatic duct diameter, body mass index, and cumulative ketorolac dose >150 mg as independent predictors of POPF (P < 0.0001, pseudo R2 = 0.149). Conclusions Increasing doses of ketorolac in the early postoperative period are associated with increased risk of POPF, whereas a cumulative dose of >150 mg is an independent predictor of POPF after PD.

Original languageEnglish (US)
Pages (from-to)43-48
Number of pages6
JournalJournal of Surgical Research
Volume221
DOIs
StatePublished - Jan 2018
Externally publishedYes

Fingerprint

Ketorolac
Pancreatic Fistula
Pancreaticoduodenectomy
Anti-Inflammatory Agents
Odds Ratio
Ketorolac Tromethamine
Pharmaceutical Preparations
Anastomotic Leak
Pancreatic Ducts
Non-Steroidal Anti-Inflammatory Agents
Postoperative Period
Pancreas
Colon
Body Mass Index
Logistic Models
Demography
Confidence Intervals

Keywords

  • Ketorolac
  • NSAIDs
  • Pancreaticoduodenectomy
  • Postoperative pancreatic fistula

ASJC Scopus subject areas

  • Surgery

Cite this

Ketorolac use may increase risk of postoperative pancreatic fistula after pancreaticoduodenectomy. / Kowalsky, Stacy J.; Zenati, Mazen S.; Steve, Jennifer; Lee, Kenneth K.; Hogg, Melissa E.; Zeh, Herbert J.; Zureikat, Amer H.

In: Journal of Surgical Research, Vol. 221, 01.2018, p. 43-48.

Research output: Contribution to journalArticle

Kowalsky, Stacy J. ; Zenati, Mazen S. ; Steve, Jennifer ; Lee, Kenneth K. ; Hogg, Melissa E. ; Zeh, Herbert J. ; Zureikat, Amer H. / Ketorolac use may increase risk of postoperative pancreatic fistula after pancreaticoduodenectomy. In: Journal of Surgical Research. 2018 ; Vol. 221. pp. 43-48.
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title = "Ketorolac use may increase risk of postoperative pancreatic fistula after pancreaticoduodenectomy",
abstract = "Background Ketorolac (Toradol), a commonly used nonselective nonsteroidal anti-inflammatory drug (NSAID) in the postoperative period, has been associated with increased risk of anastomotic leak after colon resection. The effect of postoperative NSAID and ketorolac use on postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is unknown. Methods Retrospective review of consecutive PDs at a high-volume pancreas center from 2012 to 2015. POPF was identified and graded using International Study Group on Pancreatic Fistula criteria. Demographics, operative variables and 30-d postoperative NSAID use, dosage, and timing (early = postoperative day [POD] 0-5, late > POD 5) were collected. Univariate and multivariate logistic regressions were used to identify predictors of POPF. Results Four hundred twenty-three PDs were analyzed (mean age 66 y, 47{\%} female), and 60{\%} received NSAIDs postoperatively. Ketorolac (median POD 0-5 cumulative dose = 90 mg, interquartile range 60-165) was used in 35.7{\%} (n = 151). POPF occurred in 90 patients (21.3{\%}). Early (POD 0-5) ketorolac use was associated with increased POPF, especially grade A (odds ratio [OR] 2.16, P = 0.036). Each 25 mg incremental increase in ketorolac use was associated with a 10{\%} increase in the incidence of POPF (OR 1.10, P = 0.021), whereas a cumulative dose of >150 mg was associated with a 44{\%} increased risk of POPF (OR 1.44, 95{\%} confidence interval 1.03-2.01, P = 0.035). A multivariate regression model identified estimated blood loss, soft gland, pancreatic duct diameter, body mass index, and cumulative ketorolac dose >150 mg as independent predictors of POPF (P < 0.0001, pseudo R2 = 0.149). Conclusions Increasing doses of ketorolac in the early postoperative period are associated with increased risk of POPF, whereas a cumulative dose of >150 mg is an independent predictor of POPF after PD.",
keywords = "Ketorolac, NSAIDs, Pancreaticoduodenectomy, Postoperative pancreatic fistula",
author = "Kowalsky, {Stacy J.} and Zenati, {Mazen S.} and Jennifer Steve and Lee, {Kenneth K.} and Hogg, {Melissa E.} and Zeh, {Herbert J.} and Zureikat, {Amer H.}",
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T1 - Ketorolac use may increase risk of postoperative pancreatic fistula after pancreaticoduodenectomy

AU - Kowalsky, Stacy J.

AU - Zenati, Mazen S.

AU - Steve, Jennifer

AU - Lee, Kenneth K.

AU - Hogg, Melissa E.

AU - Zeh, Herbert J.

AU - Zureikat, Amer H.

PY - 2018/1

Y1 - 2018/1

N2 - Background Ketorolac (Toradol), a commonly used nonselective nonsteroidal anti-inflammatory drug (NSAID) in the postoperative period, has been associated with increased risk of anastomotic leak after colon resection. The effect of postoperative NSAID and ketorolac use on postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is unknown. Methods Retrospective review of consecutive PDs at a high-volume pancreas center from 2012 to 2015. POPF was identified and graded using International Study Group on Pancreatic Fistula criteria. Demographics, operative variables and 30-d postoperative NSAID use, dosage, and timing (early = postoperative day [POD] 0-5, late > POD 5) were collected. Univariate and multivariate logistic regressions were used to identify predictors of POPF. Results Four hundred twenty-three PDs were analyzed (mean age 66 y, 47% female), and 60% received NSAIDs postoperatively. Ketorolac (median POD 0-5 cumulative dose = 90 mg, interquartile range 60-165) was used in 35.7% (n = 151). POPF occurred in 90 patients (21.3%). Early (POD 0-5) ketorolac use was associated with increased POPF, especially grade A (odds ratio [OR] 2.16, P = 0.036). Each 25 mg incremental increase in ketorolac use was associated with a 10% increase in the incidence of POPF (OR 1.10, P = 0.021), whereas a cumulative dose of >150 mg was associated with a 44% increased risk of POPF (OR 1.44, 95% confidence interval 1.03-2.01, P = 0.035). A multivariate regression model identified estimated blood loss, soft gland, pancreatic duct diameter, body mass index, and cumulative ketorolac dose >150 mg as independent predictors of POPF (P < 0.0001, pseudo R2 = 0.149). Conclusions Increasing doses of ketorolac in the early postoperative period are associated with increased risk of POPF, whereas a cumulative dose of >150 mg is an independent predictor of POPF after PD.

AB - Background Ketorolac (Toradol), a commonly used nonselective nonsteroidal anti-inflammatory drug (NSAID) in the postoperative period, has been associated with increased risk of anastomotic leak after colon resection. The effect of postoperative NSAID and ketorolac use on postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is unknown. Methods Retrospective review of consecutive PDs at a high-volume pancreas center from 2012 to 2015. POPF was identified and graded using International Study Group on Pancreatic Fistula criteria. Demographics, operative variables and 30-d postoperative NSAID use, dosage, and timing (early = postoperative day [POD] 0-5, late > POD 5) were collected. Univariate and multivariate logistic regressions were used to identify predictors of POPF. Results Four hundred twenty-three PDs were analyzed (mean age 66 y, 47% female), and 60% received NSAIDs postoperatively. Ketorolac (median POD 0-5 cumulative dose = 90 mg, interquartile range 60-165) was used in 35.7% (n = 151). POPF occurred in 90 patients (21.3%). Early (POD 0-5) ketorolac use was associated with increased POPF, especially grade A (odds ratio [OR] 2.16, P = 0.036). Each 25 mg incremental increase in ketorolac use was associated with a 10% increase in the incidence of POPF (OR 1.10, P = 0.021), whereas a cumulative dose of >150 mg was associated with a 44% increased risk of POPF (OR 1.44, 95% confidence interval 1.03-2.01, P = 0.035). A multivariate regression model identified estimated blood loss, soft gland, pancreatic duct diameter, body mass index, and cumulative ketorolac dose >150 mg as independent predictors of POPF (P < 0.0001, pseudo R2 = 0.149). Conclusions Increasing doses of ketorolac in the early postoperative period are associated with increased risk of POPF, whereas a cumulative dose of >150 mg is an independent predictor of POPF after PD.

KW - Ketorolac

KW - NSAIDs

KW - Pancreaticoduodenectomy

KW - Postoperative pancreatic fistula

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