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Late-Breaking Scientific Oral Presentations

Head and Neck Surgery

Session: Late Breaking Scientific Orals 1

Challenging Convention: NSAIDs in TORS Improve Outcomes Without Compromising Safety

Saturday, October 11, 2025

3:12 PM - 3:18 PM EDT

Location: 245

Introduction: Evaluate postoperative bleeding risk and readmission rates associated with NSAID use following transoral robotic surgery (TORS).

Methods: Patients undergoing TORS were identified using ICD-10 codes in TriNetX. Two sets of propensity-matched cohorts were compared: patients receiving NSAIDs (ketorolac, celecoxib, ibuprofen) within 14 days post-surgery (n=3,639) versus controls (n=3,639) and patients receiving ketorolac day of surgery (n=1,901) versus controls (n=1,901). Primary outcome was postoperative hemorrhage (ICD-10: J95.830, K91.840; CPT: 42962). Secondary outcomes include critical care admission, emergency department visit, and feeding device placement within 14 days. Statistical analysis included risk ratios with 95% confidence intervals.

Results: Postoperative bleeding rates were similar between NSAID and control groups (1.5% (55) vs 2.0% (71), RR 0.78, 95%CI 0.55-1.10, p=0.150). NSAID patients demonstrated significantly lower rates of critical care admission (2.0% (71) vs 5.2% (190), RR 0.37, 95%CI 0.29-0.49, p< 0.001) and feeding tube placement (2.7% (98) vs 4.3% (158), RR 0.62, 95%CI 0.48-0.80, p< 0.001). There was no significant increase in emergency department visits (2.2% (81) vs 2.3% (84), RR 0.96, 95%CI 0.71-1.30, p=0.813).

Secondary analysis of day-of-surgery ketorolac (n=1,901) vs control showed no increased bleeding (1.6% (30) vs 1.9% (36), RR 0.83, 95%CI 0.52-1.35, p=0.46). Ketorolac patients demonstrated significantly lower rates of critical care admission (2.2% (42) vs 4.7% (90), RR 0.47, 95%CI 0.33-0.70, p< 0.001) and feeding tube placement (1.3% (25) vs 4.5% (85), RR 0.29, 95%CI 0.19-0.46, p< 0.001). There was no significant increase in emergency department visits (2.4% (45) vs 1.9% (36), RR 1.25, 95%CI 0.81-1.93, p=0.312).

Conclusions: NSAID and ketorolac administration following TORS is not associated with an increase postoperative bleeding risk and is associated with reduced critical care utilization and feeding tube requirements. These findings support the safety of NSAIDs in multimodal analgesia protocols for TORS patients.

Presenting Author(s)

Brayden J. Seliger, BS

Medical Student
Univeristy of Toledo College of Medicine and Life Sciences
PERRYSBURG, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

JB

Jacob Beiriger, BS

Head and Neck Research Fellow
University of Utah
PITTSBURGH, Pennsylvania, United States

Disclosure information not submitted.
MB

Milana G. Berry, BS

Medical Student
Virginia Commonwealth University School of Medicine
Virginia Beach, Virginia, United States

Disclosure information not submitted.
Nilam D. Patel, MD

Assistant Professor of Otolaryngology-Head and Neck Surgery
University Hospitals Cleveland Medical Center/Case Western Reserve University
Elgin, IL, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Richard B. Cannon, MD

Assistant Professor
University of Utah - Department of Otolaryngology - Head and Neck Surgery
Salt Lake City, Utah, United States

Disclosure information not submitted.

Presenting Author(s)

MM

Marcus M. Monroe, MD

Associate Professor
University of Utah
Salt Lake City, UT, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

HM

Hilary C. McCrary, MD, MPH

Assistant Professor of Otolaryngology-Head and Neck Surgery
University of Utah - Department of Otolaryngology - Head and Neck Surgery
Salt Lake City, Utah, United States

Disclosure information not submitted.