The use of perioperative ketorolac in the surgical treatment of pediatric spontaneous pneumothorax

Background: We sought to determine the effect of ketorolac on pediatric primary spontaneous pneumothorax recurrence after operation. Methods: The Pediatric Health Information System database was queried for patients ages 10–16 years discharged in the years 2004–2014 with pneumothorax or pleural bleb and a related operative procedure. Deaths and secondary pneumothorax were excluded. Variables included demographics, chronic disease, intensive care unit admission, mechanical ventilation, and lung resection or plication. The primary variable was any ketorolac administration between post-operative day 0 and 5. Outcomes included reintervention within 1 year, readmission, post-operative length of stay (LOS), and cost. Bivariate and multivariate logistic regression analyses were performed. Results: Of 1678 records that met inclusion criteria, 395 (23%) were subsequently excluded, leaving 1283 patients for analysis. Most patients had a lung resection recorded (78%) and the majority were administered ketorolac (57%); few required reintervention (20%) or readmission (18%). Mean postoperative LOS was 5.2 ± 3.8 days and mean cost was $17,649 ± $10,599. On bivariate analysis, ketorolac administration did not correlate with any measured outcome. On both bivariate and 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. Level of evidence and type of study: Level III treatment study.