Safety of perioperative ketorolac administration in pediatric appendectomy

Abstract Background Recent studies in adults undergoing gastrointestinal surgeries show an increased rate of complications with the use of ketorolac. This calls into question the safety of ketorolac in certain procedures. We sought to evaluate the impact of perioperative ketorolac administration on...

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Bibliographic Details
Published in:The Journal of surgical research 2017-10, Vol.218, p.232-236
Main Authors: Naseem, Hibbut-ur-Rauf, MD, Dorman, Robert Michael, MD, Ventro, George, MD, Rothstein, David H., MD, MS, Vali, Kaveh, MD
Format: Article
Language:English
Subjects:
Adolescent
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Appendectomy - adverse effects
Appendectomy - statistics & numerical data
Child
Child, Preschool
Female
Humans
Ketorolac - adverse effects
Length of Stay
Male
Nonsteroidal anti-inflammatory drugs
Patient Readmission - statistics & numerical data
Pediatric surgery
Postoperative Complications - etiology
Primary appendicitis
Retrospective Studies
Surgery
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Summary:Abstract Background Recent studies in adults undergoing gastrointestinal surgeries show an increased rate of complications with the use of ketorolac. This calls into question the safety of ketorolac in certain procedures. We sought to evaluate the impact of perioperative ketorolac administration on outcomes in pediatric appendectomy. Methods The Pediatric Health Information System database was queried for patients aged 5-17 y with a primary diagnosis of appendicitis and a primary procedure of appendectomy during the period 2010-2014. Patients with procedures suggesting incidental appendectomy, those records with data quality issues, deaths, and extracorporeal membrane oxygenation were excluded. Variables recorded included age, sex, race, ethnicity, discharge year, complex chronic conditions, geographic region, intensive care unit admission, mechanical ventilation, and whether appendicitis was coded as complicated. The exposure variable was ketorolac administration on the day of or day after operation. The primary outcomes of interest were any surgical complications during the initial encounter, postoperative length of stay (LOS), total cost for the initial visit, any readmission to ambulatory, observation, or inpatient status within 30 d, and readmission with a diagnosis of peritoneal abscess or other postoperative infection or with transabdominal drainage performed. Results A total of 78,926 patients were included in the analysis cohort. Mean age was 11.4 y (standard deviation 3.3 y), the majority were males (61%), White (70%), and non-Hispanic (65%). Few had a complex chronic condition (3%) or required mechanical ventilation (2%) or an intensive care unit admission (1%). Patients with complicated appendicitis comprised 28% of the cohort. Most (73%) received ketorolac on postoperative day 0-1; those with complicated appendicitis were more likely to receive ketorolac. In all, 2.6% of the cohort had a surgical complication during the index visit, 4.3% were readmitted within 30 d, and 2% had a postoperative infection or transabdominal drainage (1% in the uncomplicated group and 5% in the complicated group). Median postoperative LOS was 1 d and mean cost was $9811 ± $9509. On bivariate analysis, ketorolac administration was associated with a decrease in same-visit surgical complications ( P  = 0.004) and cost ($459 decrease, P  
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2017.05.087