Author(s)
Jason C. DeGiovanni, MD
Francesca Viola
Kiana Saade
Matthew Kabalan
Mattie R. Rosi-Schumacher, MD
Michele M. Carr, MD, DDS, MEd, PhD
Affiliation(s)
Jacobs School of Medicine and Biomedical Sciences, Dept of Otolaryngology; Jacobs School of Medicine and Biomedical Sciences; Jacobs School of Medicine and Biomedical Sciences at the State University of New York at Buffalo; SUNY University at Buffalo, Dept of Otolaryngology;
Abstract:
Introduction: There is controversy regarding the effect of using non-steroidal anti-inflammatory medications post-tonsillectomy on risk of bleeding. Our goal was to review local outcomes when 1 intraoperative dose of ketorolac was used during pediatric tonsillectomy.
Methods: Charts were reviewed for all pediatric patients undergoing tonsillectomy by pediatric otolaryngologists in 1 institution between 1/2019 and 5/2020. Age, gender, indication for surgery, co-morbidities, surgeon, resident participation, technique, intraoperative medications, and postoperative medications were reviewed and logistic regression calculated for post-op hemorrhage.
Results: 1093 patients had complete data. Mean age was 7.0 yrs (95% CI 6.8-7.3), 526 were female (48.1%) and 567 male (51.9%). 893 (81.7%) had surgery for obstruction and 200 (18.3%) had surgery for recurrent infection. 331 (30.3%) had otolaryngology residents involved in their surgery. 846 (77.4%) had monopolar dissection done, 237 (21.7%) had bipolar dissection, and 9 (0.8%) had coblation tonsillectomy. 662 (60.6%) had intra-operative ketorolac used. 1085 (99.3%) had intra-op dexamethasone, 1003 (91.8%) had intra-op morphine, and 47 (4.3%) had intra-op fentanyl. All were advised to use ibuprofen post-op. 72 (6.6%) had a post-op hemorrhage, 7 (0.6%) were within 24 hours. 3 had von Willebrand’s disease and none of these had post-op hemorrhage. Logistic regression showed that only age was significantly associated with post-op hemorrhage (ß=.138, p
Conclusions: We did not demonstrate that a single intra-op dose of ketorolac in this population was associated with a change in post-tonsillectomy hemorrhage.