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The Safety of Ketorolac in Pediatric Outpatient Penile Surgery
Patrick Meade, BA, Ilina Rosoklija, MPH, Lauren Balmert, PhD, Dennis Liu, MD.
Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

BACKGROUND: Ketorolac is an effective analgesic alternative to opioids, and a useful adjunct for perioperative pain management. However, concerns exist about its use due to potential bleeding complications. In this study, we examined Ketorolac's safety for use following outpatient pediatric penile surgeries, specifically postoperative bleeding complications.
METHODS:
We used the Pediatric Health Information System (PHIS) database to identify males (3 months - 18 years) who underwent penile surgery 1/2010 - 12/2017 at 45 children's hospitals. All patients had a qualifying initial encounter for penile surgery as their primary procedure, and all subsequent hospital encounters within 30 days were assessed. This included emergency department visits, ambulatory surgeries, and inpatient/observation admissions. Penile surgeries were identified using procedural codes, and included circumcision, chordee release, hypospadias repair, and penoplasty performed under general anesthesia. Patients with complex chronic conditions or intraoperative complications were excluded. We divided our cohort into two groups: patients who received ketorolac and those who did not. The primary outcome was a return encounter for a bleeding complication within 30 days of the procedure. The secondary outcome was a return encounter within 30 days for any reason. A multivariable logistic model was used to examine the association between ketorolac and a return encounter, adjusting for race/ethnicity.
RESULTS:
A total of 190,665 qualifying procedures were identified with 26,023 (14%) patients receiving ketorolac. Older patients were significantly more likely to receive ketorolac than younger patients (mean age: 3.58 vs. 1.44 years, p=<0.001) (Table 1). There were 9,374 (4.9%) return encounters for any reason within 30 days and 609 (0.32%) return encounters due to bleeding. We found no significant association between perioperative ketorolac and a return encounter for any reason (p=0.259) or a return encounter for a bleeding complication (p=0.101) (Table 1). After adjusting for race/ethnicity using a multivariable logistic model, ketorolac administration was also not significantly associated with a return encounter for any reason (p=0.1065) or for bleeding (p =0.1131) (Table 2).




CONCLUSIONS: The use of ketorolac for perioperative pain management following outpatient penile surgery was not associated with an increased risk of post-operative return visit, including for post-operative bleeding complications. Consistent with findings from other surgical specialties in the literature, our study suggests that ketorolac is a safe perioperative analgesic for pediatric penile surgeries.


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