Opioid analgesics versus ketorolac in spine and joint procedures: Impact on healthcare resources

BACKGROUND: Ketorolac's efficacy as a postoperative analgesic has been show n to be comparable to that of narcotic analgesics, but with significantly f ewer narcotic-related adverse events. OBJECTIVE: To assess whether the choice of postoperative analgesic, narcoti c or ketorolac, has an impact on healthcare resource utilization and cost d uring inpatients' recovery period. DESIGN: Retrospective, multicenter, controlled, parallel, cost-minimalizati on analysis. SETTING: Six US teaching hospitals. PATIENTS: This study included 559 patients that underwent either a spine or joint procedure and received adequate doses of narcotic (n = 284 of either morphine or meperidine) or ketorolac (n = 275). MEASUREMENTS: Time to reach recovery milestones, average utilization of hea lthcare resources, and average per-case post-operative treatment cost. RESULTS: Several recovery milestones, including time to first bowel movemen t, first oral intake, and first unassisted ambulation, were reached sooner in the ketorolac group, with a resultant shorter mean length of postoperati ve stay (narcotic 3.78 d, ketorolac 2.80 d; p = 0.01). Total per-patient co st of treatment was 32% greater in the narcotic group, resulting primarily from higher costs associated with hospitalization. CONCLUSIONS: Despite the higher acquisition cost of medication, healthcare resource utilization and total per-patient cost of treatment were lower for patients in the ketorolac group compared with patients in the narcotic ana lgesic study group. The majority of patients in the ketorolac group were al so given concurrent narcotic analgesics; therefore, the beneficial effects observed may be secondary to the combination of ketorolac and narcotic anal gesics.