Preoperative ketorolac is associated with increased nonunion repair following femoral intramedullary nailing: a retrospective cohort study

PURPOSE: Nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are widely used for perioperative analgesia, but their effects on bone healing remain debated. This study evaluates associations between preoperative intravenous ketorolac and outcomes on bone healing after femoral intramedullary nailing (IMN). METHODS: Using the TriNetX database, we conducted a retrospective cohort analysis of adults undergoing femoral IMN who received a single preoperative IV ketorolac dose. Propensity score matching (1:1) produced 2 cohorts (n = 8,466 each). Outcomes included wound disruption, infection, sepsis, thromboembolism, mortality, readmission, and nonunion/malunion repair. Risk ratios, 95% confidence intervals, and P values were calculated (P < 0.05). RESULTS: Ketorolac was associated with increased wound disruption (P = 0.034), and nonunion/malunion repair (P = 0.015), but decreased mortality (P = 0.014) and readmission (P = 0.009). CONCLUSION: Preoperative ketorolac exposure was associated with higher rates of operative treatment of nonunion/malunion, although these findings should be interpreted cautiously because of substantial residual confounding and exposure misclassification. LEVEL OF EVIDENCE: Level III, Prognostic.