“Toradol® following breast surgery: Is there an increased risk of hematoma?”

Background: Ketorolac tromethamine (Toradol®), a nonsteroidal antiinflammatory drug, is used with increased frequency given its success in postoperative pain control and the subsequent decreased need for narcotics. Its use has been limited in plastic surgery for fear of postoperative bleeding and hematoma formation. In this study of breast surgery patients, we investigated whether ketorolac increased the risk of postoperative hematoma formation. Methods: After obtaining institutional review board approval, we retrospectively reviewed the records of patients undergoing breast surgery (breast reduction and autologous or implant based reconstruction) from January 2012 through December 2014. Excluded were patients who underwent the first stage of breast reconstruction before January 2012. We compared the incidence of postoperative hematomas in patients who did, versus those who did not, receive ketorolac postoperatively. In addition, we documented other risk factors, such as chronic anticoagulation, aspirin use, or coagulopathies. Results: For our entire cohort, the overall hematoma rate was 2.8%. Of the patients who received ketorolac, the rate was 3.5% of those who did not, 2.5%. Of the breast reduction patients, the rate was 4% in those who received ketorolac vs. 3.2% in those who did not. Of the breast reconstruction patients, the rate was 4% in those who received ketorolac vs. 3.2% in those who did not. Conclusion: In recent years, the high rates of prescribing postoperative narcotics have received increased attention. Aside from the risk of increased availability of narcotics in the community, the side effects of nausea, pruritus, and constipation can delay patient recovery. Ketorolac is controversial for postoperative pain control because of the potential risk of bleeding, but in our 3-year retrospective study, it was not associated with an increased risk of hematoma formation. Financial Disclosure Statement: The authors have nothing to disclose. Presented at: Aesthetica Super Symposium 2017 in New Orleans, LA, Minnesota Surgical Society 2017 in Minneapolis, MN Corresponding Author: Brittany Nguyen, BS, 420 Delaware ST SE, Minneapolis, MN 55455 nguy446@umn.edu, 651-492-3098 ©2018American Society of Plastic Surgeons