Safety of Ketorolac in Primary Total Hip Arthroplasties: An Analysis of over 7,000 Cases.

Abstract

Ketorolac is commonly utilized perioperatively in primary total hip arthroplasty (THA), either intravenously (IV) or via periarticular infiltration analgesia (PAI). While effective for pain control, concerns remain regarding its potential to cause acute kidney injury (AKI), particularly in patients who have chronic kidney disease (CKD). This study evaluated the association between perioperative ketorolac administration and postoperative AKI, stratified by baseline renal function and administration route. We retrospectively analyzed 7,211 inpatient THAs performed between 2011 and 2021. An AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regressions evaluated the association between perioperative ketorolac administration and in-hospital AKI, adjusting for demographic and clinical covariates. Subgroup analyses were conducted for patients who had (15%) and did not have (85%) preexisting CKD. Ketorolac was administered perioperatively in 35% of cases (25% periarticular infiltration analgesia, 7% intravenously, and 3% both) with a median cumulative dose of 30 mg (range, 15 to 90 mg). The mean age was 66 years, mean body mass index (BMI) 31 and 51% were women. An AKI occurred in 3.4% of cases. Ketorolac use was not associated with increased AKI risk (odds ratio (OR) 0.8; P = 0.08), regardless of administration route (all OR less than 1; all P > 0.05). Chronic kidney disease was an independent risk factor for the development of AKI (OR 4.1; P < 0.001). In patients who did not have CKD, ketorolac use was associated with a decreased risk of AKI (OR 0.6; P = 0.03) and not associated with an increased or decreased risk in those who have CKD (OR 1.1; P = 0.80). Additional independent risk factors for AKI included intraoperative transfusion (OR 4.4; P < 0.001), new-onset atrial fibrillation (OR 3; P < 0.001), history of hypertension (OR 2.2; P < 0.001), men (OR 1.4; P = 0.047), and elevated BMI (OR 1.04 per unit increase, P < 0.001). Perioperative ketorolac use does not elevate the postoperative AKI risk, regardless of administration route. Risk factors for AKI include preexisting CKD, men, elevated BMI, need for intraoperative transfusion, and history of hypertension.