Barkho Jouseph O, Li Yu Kit, Duku Eric, Thoma Achilleas
Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Private practice, Plastic and Reconstructive Surgery Associates, San Jose, California, United States; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; and Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
Plast Reconstr Surg Glob Open. 2018 Mar 19;6(3):e1699. doi: 10.1097/GOX.0000000000001699. eCollection 2018 Mar.
Ketorolac is a potent nonsteroidal anti-inflammatory drug that has valuable analgesic properties but also a hypothetical risk of increased bleeding due to inhibition of platelet activation. The clinical significance of this risk, however, is unclear when it is used after reduction mammaplasty. Our study objective was to therefore examine the association between ketorolac exposure and hematoma occurrence after breast reduction surgery. We hypothesized that there was no association between ketorolac exposure and hematoma occurrence in breast reduction surgery.
A case-control design was used. Data from charts of all reduction mammaplasties that developed hematomas requiring surgical evacuation (cases) at our university-based hospitals were retrieved and matched to data from charts of reduction mammaplasty patients who did not indicate this complication (controls). Matching occurred in a 1:1 ratio based on 4 criteria: age, body mass index, institution, and preexisting hypertension. Charts were reviewed for retrospective information on exposure to ketorolac. Odds ratio (OR) was calculated with an OR > 1 favoring an association.
From 2002 to 2016, 40 cases of hematoma met inclusion criteria and were matched with 40 controls (N = 80). Cases had a significantly lower body mass index than controls; however, the other baseline patient demographics were similar between the 2 groups. There was an association between hematoma formation and exposure to ketorolac (OR, 2.4; 95% confidence interval, 0.8-7.4; = 0.114) and a trend for greater risk of hematoma formation, although this was not statistically significant.
Based on this level 3 evidence, there appears to be an association between perioperative ketorolac exposure and hematoma after breast reduction surgery, but it was not statistically significant. Although this study was adequately powered, the OR of 2.4 was associated with a wide confidence interval. A larger sample size may increase the precision of the results and may also make the association definitive.
酮咯酸是一种强效非甾体抗炎药，具有显著的镇痛特性，但因抑制血小板活化而存在出血风险增加的潜在可能性。然而，在缩乳术后使用时，这种风险的临床意义尚不清楚。因此，我们的研究目的是探讨酮咯酸暴露与缩乳术后血肿发生之间的关联。我们假设在缩乳手术中，酮咯酸暴露与血肿发生之间无关联。
采用病例对照设计。检索我校附属医院所有因血肿需手术引流的缩乳术病历资料（病例组），并与未出现该并发症的缩乳术患者病历资料（对照组）进行匹配。根据年龄、体重指数、医疗机构和既往高血压4项标准按1:1比例进行匹配。回顾病历以获取酮咯酸暴露的回顾性信息。计算比值比（OR），OR>1表示存在关联。
2002年至2016年，40例血肿符合纳入标准，并与40例对照匹配（N = 80）。病例组的体重指数显著低于对照组；然而，两组间其他基线患者人口统计学特征相似。血肿形成与酮咯酸暴露之间存在关联（OR，2.4；95%置信区间，0.8 - 7.4；P = 0.114），且有血肿形成风险增加的趋势，尽管无统计学意义。
基于这一3级证据，围手术期酮咯酸暴露与缩乳术后血肿之间似乎存在关联，但无统计学意义。尽管本研究样本量充足，但OR为2.4，置信区间较宽。更大的样本量可能会提高结果的精确性，也可能使该关联更具确定性。
