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.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.