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.

摘要

OBJECTIVE: This study was designed to determine the effect of ketorolac on mortality after cardiac surgery. DESIGN: A retrospective multivariable analysis with propensity matching and propensity scoring. SETTING: A tertiary care university-affiliated medical center. PARTICIPANT: Eleven hundred eighty-six patients undergoing isolated coronary artery bypass surgery. MAIN 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). CONCLUSION: The use of ketorolac was associated with a statistically significant decrease in mortality at follow-up.