Does perioperative ketorolac increase bleeding risk after intracapsular tonsillectomy?

Area of Science:

• Pediatric Surgery
• Anesthesiology
• Otolaryngology

Background:

• Conflicting evidence exists on ketorolac's post-tonsillectomy bleed risk in children.
• Surgical technique, such as intracapsular tonsillectomy, may influence this risk.

Purpose of the Study:

• To assess the post-tonsillectomy bleed rate after single-dose ketorolac in pediatric patients undergoing intracapsular tonsillectomy.
• To identify patient factors (age, sex, BMI, comorbidities) associated with increased bleed risk.

Main Methods:

• Retrospective cohort study of 1920 children (Jan 2017-Dec 2018) at a tertiary pediatric center.
• Two cohorts: ketorolac (K+, n=1458) vs. no ketorolac (NK, n=462).
• Primary outcome: post-tonsillectomy hemorrhage requiring operative intervention.

Main Results:

• Overall postoperative bleeding rate was 1.5%.
• No significant difference in bleeding rates between K+ (1.4%) and NK (1.7%) groups (P=0.82).
• Risk factors for hemorrhage included age, chronic tonsillitis, higher BMI Z-scores, ADHD, and behavioral diagnoses.

Conclusions:

• Single-dose ketorolac is not associated with increased post-tonsillectomy bleeding risk in pediatric patients undergoing intracapsular tonsillectomy.
• Clinicians can confidently use ketorolac in this population without increased bleeding concerns.