Perioperative Ketorolac Not Associated With Increased Hemorrhage After Pediatric Tonsillectomy

Monday, October 2, 2023

3:51 PM - 3:57 PM East Coast USA Time

Location: 202A

Presenting Author(s)

Maxwell D. Newby, MD

Fellow
Seattle Children's Hospital, University of Washington
Seattle, WA, United States

Co-Author(s)

JS

Jennifer Siu, MD

Seattle Children's Hospital, USA

Senior Author(s)

RF

Rachel Feldman, MD

Seattle Children's Hospital, USA

Co-Author(s)

Vikas N. O'Reilly-Shah, MD, PhD

Associate professor
Seattle Children's Hospital
Seattle, WA, United States
Jake P. Dahl, MD, PhD, MBA

Associate Professor of Pediatric Otolaryngology
University of Washington, Seattle Children's Hospital
Seattle, WA, United States
Sanjay R. Parikh, MD

Professor
University of Washington / Seattle Children's Hospital
Seattle, WA, United States
AF

Amber Franz, MD

Seattle Children's Hospital, USA

Disclosure(s):

Jake P. Dahl, MD, PhD, MBA: No relevant relationships to disclose.

Introduction: Ketorolac has historically been avoided in pediatric tonsillectomy due to fear of elevated post-operative bleeding risk. The current literature neither supports nor refutes this statement.

Methods: This retrospective cohort study evaluated patients who underwent tonsillectomy at a tertiary care pediatric center from January 2015 to October 2020. Post-tonsillectomy bleed was defined by the need for reoperation for control of tonsillar hemorrhage. To adjust for differences in baseline covariates, including ASA, age, race/ethnicity, and surgical indication, one-to-one nearest-neighbor propensity score matching was conducted between patients who received keterolac (K+) and those who did not (K-). Differences in the total cohort were calculated using chi-square test; differences in the propensity matched cohort were calculated using conditional logistic regression.

Results: The total cohort included 6181 patients, of whom 2661 (43.1%) received a single dose of ketorolac, either intraoperatively or in PACU. There was no significant difference when comparing 30-day postoperative bleeding rate between patients receiving keterolac (n=52, 2.0%) and those patients who did not (n=61, 1.7%) [p=0.584]. Similarly, there was no difference in early post-tonsillectomy bleeding rate (within 48 hours) between those receiving ketorolac (0.6%) and those that did not (0.6%), [p=0.849]. Within the propensity matched cohort (2499 patients per group), use of keterolac was not associated with a higher incidence of 30-day post-tonsillectomy bleed rate [K+ (n=50, 2.0%) vs K- (n=45, 1.8%), p=0.60] and also not associated with a higher incidence of early postoperative bleed within 48 hours [K+ (n=16, 0.6%) vs. K- (n=14, 0.6%), p=0.71].

Conclusions: Single-dose intraoperative or postoperative ketorolac is not associated with increased risk of early or late post-tonsillectomy hemorrhage in pediatric patients undergoing tonsillectomy. Providers should consider using ketorolac in patients undergoing tonsillectomy as it does not appear to increase bleeding risk.