Doctor of Nursing Practice (DNP) Projects

Date of this Version

5-8-2019

Embargo Date

5-8-2020

Document Type

Project

Department

Nursing

Track

Post-BSN for Nurse Anesthetists (DNP-NA)

Keywords

ketorolac, colorectal surgery, postoperative bleeding

Abstract

Background Ketorolac is an effective analgesic adjunct and is currently used in Enhanced Recovery After Surgery (ERAS) protocols. However, investigation into its safety profile is warranted in specific surgical populations. This Quality Improvement (QI) study sought to examine the association of ketorolac to increased postoperative bleeding risk, increased postoperative renal impairment, and 30-day readmission within an ERAS protocol for colorectal surgery.

Methods A retrospective review was conducted of 158 patients enrolled in an existing ERAS protocol for colorectal surgery with at least one dose of ketorolac administered in the perioperative period. Outcomes of postoperative bleeding, 30-day readmission, and preoperative/postoperative serum creatinine levels were assessed.

Results There was no statistically significant difference in the incidence of postoperative bleeding compared to a known population. There was a significant association of 30-day readmissions with documented evidence of bleeding (P = 0.037). There was no significant change in the preoperative and postoperative serum creatinine. Multivariate logistic regression analysis found no association of postoperative bleeding with pre-existing chronic non-steroidal anti-inflammatory drug (NSAID) use or preoperative serum creatinine.

Conclusions Ketorolac is not associated with an increased risk of postoperative bleeding in colorectal ERAS surgical patients. However, postoperative bleeding does predict the likelihood for 30-day readmissions.

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Date Posted: 25 February 2022