• STUDY DESIGN
    • Retrospective cohort study.
  • OBJECTIVE
    • To evaluate opioid utilization and pseudoarthrosis risk following lumbar spinal fusion in patients receiving postoperative ketorolac versus those who did not. Background: Ketorolac is increasingly used in multimodal pain regimens to reduce opioid use. However, its effect on bone healing, particularly after lumbar fusion, remains unclear.
  • METHODS
    • Using the TriNetX database, we identified patients undergoing lumbar spinal fusion with ≥30 days of follow-up, excluding those with prior pseudoarthrosis. Patients were grouped by postoperative ketorolac use and matched 1:1 by sex, age, ethnicity, and comorbidities. Primary outcomes included opioid prescriptions at 7, 14, and 30 days. Pseudoarthrosis was assessed at 1 and 2 years. Secondary outcomes included bowel regimen use, ileus, DVT, PE, AKI, transfusion, infection, wound disruption, lab values (Hgb, Hct, Cr), readmissions, ED visits, and mechanical complications at 1 and 2 years.
  • RESULTS
    • After matching, 15,260 patients were included in each group. Ketorolac use was associated with fewer opioid prescriptions at all short-term timepoints (e.g., 2.5 vs. 2.8 at 7 days, P<0.001) and less bowel regimen use (P<0.001). DVT, PE, and ileus risk were lower in the ketorolac group (P<0.05). No increase in AKI, Cr, or transfusion rates was observed. At 1 and 2 years, ketorolac users had reduced mechanical complications and comparable pseudoarthrosis rates.
  • CONCLUSIONS
    • Postoperative ketorolac may reduce short-term opioid use and thromboembolic risk without increasing pseudoarthrosis or mechanical complications. These findings support ketorolac as a potentially safe adjunct in postoperative pain management. Further randomized trials are warranted.