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A retrospective quality improvement study of ketorolac use following spinal fusion in pediatric patients
Pamela L Horn1, Sharon Wrona, Allan C Beebe
1Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Short-term ketorolac use in pediatric spinal fusion patients did not show increased risks of pseudarthrosis, nonunion, or instrumentation failure. This study suggests safety in this population, contrasting adult data.
Area of Science:
- Orthopedic Surgery
- Pediatric Spine Surgery
- Pharmacology
Background:
- Ketorolac use post-spinal fusion in adults is linked to higher risks of pseudarthrosis, nonunion, and instrumentation failure.
- Limited research exists on ketorolac's safety and efficacy in pediatric spinal fusion patients, particularly for short-term use.
Purpose of the Study:
- To evaluate the safety and outcomes of short-term ketorolac administration in pediatric patients following spinal fusion surgery.
- To compare the incidence of pseudarthrosis, nonunion, and instrumentation failure in pediatric spinal fusion patients who received ketorolac versus those who did not.
Main Methods:
- Retrospective chart review of 46 pediatric scoliosis patients undergoing spinal fusion (July 2003-August 2005).
- Patients were divided into two groups: 25 received ketorolac, and 21 did not.
- Comparison of length of stay, curve progression, nonunion, and instrumentation failure rates between the groups.
Main Results:
- At 1-year follow-up (95% return rate) and 3-year follow-up (52% return rate), no clinical or radiographic evidence of curve progression was observed.
- No instances of nonunion or instrumentation failure were reported in either group at the 3-year follow-up.
- Short-term ketorolac use did not appear to negatively impact surgical outcomes in this pediatric cohort.
Conclusions:
- Short-term ketorolac administration appears safe in pediatric patients undergoing spinal fusion for scoliosis.
- The findings suggest that ketorolac may not increase the risks of pseudarthrosis, nonunion, or instrumentation failure in this specific pediatric population.
- Further research is warranted to confirm these findings in larger, prospective studies.
Background:
There are studies and literature that support the claim that ketorolac use after spinal fusion in the adult population can increase the risk of pseudarthrosis, instrumentation failure, and/or nonunion. There is limited research when using ketorolac in the pediatric population, especially short-term use.
Methods:
Chart review of 46 pediatric patients who had prior spinal fusions for scoliosis between July 2003 and August 2005. Twenty-five of the patients received ketorolac and 21 did not. The lengths of stay, incidence of curve progression, and/or incidence of nonunion or instrumentation failure were compared in the 2 groups.
Results:
At the 1-year follow-up, 95% of the patients returned and at the 3-year follow-up, 52% of the patients returned and there was no clinical or radiographic evidence of curve progression, nonunion, or instrumentation failure.
Level Of Evidence:
This is a retrospective study looking at results of 2 patient groups. This is a level III study.
