Association Between Postoperative NSAID Use and Bleeding Following Transoral Robotic Surgery

OBJECTIVE: To evaluate the safety and outcomes of NSAID use following transoral robotic surgery (TORS). STUDY DESIGN: Retrospective cohort study using propensity score matching. SETTING: Multi-institutional database (TriNetX). METHODS: Patients undergoing TORS were identified using ICD-10 codes. Two propensity-matched cohorts were compared: (1) patients receiving NSAIDs (ketorolac, celecoxib, ibuprofen) within 14 days postsurgery (n = 3639) versus controls (n = 3639) and (2) patients receiving ketorolac day-of-surgery (n = 1901) versus controls (n = 1901). Primary outcome was postoperative hemorrhage. Secondary outcomes included critical care admission, emergency department visit, and feeding device placement within 14 days. RESULTS: Postoperative bleeding rates were similar between NSAID and control groups (P = .150). Patients treated with NSAIDs had lower rates of critical care admission (P < .001) and feeding tube placement (P < .001). Emergency department visits showed no significant difference (P = .813). Day-of-surgery ketorolac versus control showed no increased bleeding (P = .460). Ketorolac patients demonstrated significantly lower rates of critical care admission (P < .001) and feeding tube placement (P < .001), with no increase in emergency department visits (P = .312). CONCLUSION: NSAID administration following TORS was not associated with increased postoperative hemorrhage. NSAID use was associated with reduced critical care utilization and feeding tube requirements. These findings support the safety of NSAIDs in multimodal analgesia protocols for TORS patients.