Summary
Introduction & Objective
The opioid crisis has raised concerns for long-term sequela of routine administration
of opioids to patients, particularly in the pediatric population. Nonsteroidal anti-inflammatory
drug use is limited in hypospadias surgery due to concerns for post-operative bleeding,
particularly with ketorolac. We hypothesize that ketorolac administration at the time
of hypospadias repair is not associated with increased bleeding or immediate adverse
events.
Methods
A retrospective single institution study included all patients undergoing hypospadias
surgery from 2018 to 2021. Outcomes measured include peri-operative ketorolac administration,
opioid prescriptions, and unplanned encounters (i.e., emergency department or office
visits). Comparative statistics using non-parametric and binary/categorical tests
and a logistic regression were performed.
Results
1044 patients were included, among whom there were 562 distal, 278 proximal and 204
hypospadias complication repairs. Ketorolac was administered to 396 (37.9%) patients
and its utilization increased during the study period [Summary Figure]. Patients receiving
ketorolac were older (p = 0.002) and were prescribed opioids less often after surgery
(2.0% vs 5.2%, p = 0.009). There was no difference in unplanned encounters across
repair types (p = 0.1). Multivariate logistic regression showed ketorolac use was
not associated with an increased likelihood of an unplanned encounter.
Discussion
The use of NSAIDs post-operatively has traditionally been limited due to concerns
about bleeding risks, however the present study displayed no significant increases
in unplanned patient encounters either in the ED or outpatient clinic after ketorolac
administration.
Our study has several limitations including its retrospective and single-institutional
design, difficulties of pain assessment in pediatric population, and possibility of
under estimation of unplanned encounters due to limited access to patients’ records
outside of our institution.
Conclusions
Graphical AbstractProportion of hypospadias surgery receiving Ketorolac, opioid prescriptions, ED visits
within 30 days and Office Visit within 5 days.
Keywords
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Article info
Publication history
Published online: January 29, 2023
Accepted:
January 23,
2023
Received in revised form:
January 6,
2023
Received:
April 5,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
