R. M. Dorman1,2, G. Ventro1,2, S. Cairo1, K. Vali1,2, D. H. Rothstein1,2 1Women And Children’s Hospital Of Buffalo,Pediatric Surgery,Buffalo, NY, USA 2State University Of New York At Buffalo,Pediatric Surgery,Buffalo, NY, USA
Introduction:
The effect of post-opertative anti-inflammatory medications on pleurodesis success after treatment of spontaneous pneumothorax is uncertain. We sought to determine if the use of post-operative ketorolac is associated with an increased risk of recurrence in the surgical treatment of primary spontaneous pneumothorax in children.
Methods:
The Pediatric Health Information System database was queried for all patients age 10-16 years discharged ibetween 2004-2014 with a primary diagnosis of pneumothorax or pleural bleb and a thoracotomy, thoracoscopy, or lung resection procedure. Deaths, encounters representing readmission after previous operative treatment of pneumothorax in the prior year, patients requiring extra-corporeal life support, and patients with diagnoses or concurrent procedures that may lead to secondary or iatrogenic pneumothorax were excluded. Variables included basic demographics, discharge in the first or second half of the study period, chronic renal or hematologic disease, intensive care unit admission or post-operative mechanical ventilation, and whether a lung resection or plication was coded. The primary predictor of interest was ketorolac administration any time in the period from post-operative day 0 to 5. The primary outcomes of interest were thoracentesis, thoracostomy, thoracotomy, thoracoscopy, lung resection or plication, or pleurodesis within 1 year of the index admission. Bivariate analyses were carried out for all outcomes and multivariate logistic regression analyses were then performed for reintervention and readmission.
Results:
1,678 records met inclusion criteria. Three hundred ninety-five (23%) were subsequently excluded (227 readmissions and the remainder for one of the above-listed criteria), leaving 1,283 patients for analysis. The cohort was predominately male (79%), white (74%), and older (mean age 15.5 ± 1.2 years). Most patients had some lung resection recorded (78%), a majority were administered ketorolac (57%), and few required reintervention (20%) or readmission (18%). Mean postoperative length of stay was 5.2 ± 3.8 days and mean cost was $17,649 ± $10,599. Older patients and those in the earlier years of the study were more likely to receive ketorolac. There was significant variation in frequency of ketorolac administration by geographic region, ranging from 32% to 68%. On multivariate analysis, no variable was predictive of reintervention, and only lung resection correlated with readmission (adjusted odds ratio 0.63 [95% C.I. 0.45-0.90]).
Conclusion:
Post-operative ketorolac administration was not associated with an increased likelihood of reintervention or readmission within 1 year of operative treatment of primary spontaneous pneumothorax, suggesting that it may be used safely as part of a post-operative pain control regimen. Effects on postoperative length of stay and cost, however, were not demonstrated.