Impact of Ketorolac on Reoperation for Hemorrhage After Pediatric Tonsillectomy: A Single‐Center Retrospective Propensity‐Matched Study

• Published in: Otolaryngology-head and neck surgery Vol. 170; no. 3; pp. 928 - 936
• Main Authors: Feldman, Rachel M., O'Reilly‐Shah, Vikas, Dahl, John P., Siu, Jennifer, Newby, Maxwell, Sutherland, Tori N., Parikh, Sanjay R., Jiang, Teresa, Franz, Amber
• Format: Journal Article
• Language: English
• Published: England 01-03-2024
• Subjects: Adolescent; Child; Hemorrhage; Humans; ketorolac; Ketorolac - adverse effects; pediatric adenotonsillectomy; pediatric tonsillectomy; Postoperative Hemorrhage - chemically induced; posttonsillectomy hemorrhage; Reoperation; Retrospective Studies; Tonsillectomy - adverse effects; pediatric adenotonsillectomy; posttonsillectomy hemorrhage; ketorolac; pediatric tonsillectomy
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1002/ohn.577

Objective
To determine if perioperative ketorolac is associated with an increased rate of reoperation for hemorrhage after pediatric tonsillectomy at 30 days and 48 hours.
Study Design
Single‐center retrospective propensity‐matched study.
Setting
Quaternary pediatric hospital and ambulatory surgery center.
Methods
Patients less than 18 years old undergoing tonsillectomy or adenotonsillectomy between January 1, 2015 and October 1, 2020 were included. Hemorrhage rates between exposed (K+) and unexposed (K−) patients were calculated for the total cohort and a 1:1 propensity‐matched cohort. Additional analyses included: multivariable logistic regression, subgroup analysis of ASA 1 and 2 patients, subgroup analysis comparing children with teenagers.
Results
There were 5873 patients (42.1% K+) in the full cohort and 4694 patients in the propensity‐matched cohort. Reoperation for hemorrhage within 30 days occurred in 1.9% of K+ patients and 1.6% of K− patients (P = 0.455) in the full cohort and 1.9% of K+ patients and 1.7% of K− patients (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.72‐1.69, P = 0.662) in the propensity‐matched cohort. Reoperation within 48 hours occurred in 0.65% of K+ patients and 0.53% of K− patients (P = 0.679) in the full cohort and 0.68% of K+ patients and 0.51% of K− patients (OR 1.33, 95% CI 0.63‐2.81, P = 0.451) in the propensity‐matched cohort. There was no association between perioperative ketorolac administration and reoperation for hemorrhage in any of the other analyses.
Conclusion
Ketorolac at end of surgery should be considered as part of the nonopioid analgesic regimen for pediatric tonsillectomy.