Perioperative ketorolac increases post‐tonsillectomy hemorrhage in adults but not children

Abstract

Objectives/Hypothesis To evaluate the risk of post‐tonsillectomy hemorrhage associated with perioperative ketorolac use. Study Design Systematic review and meta‐analysis of primary articles reporting individual‐level post‐tonsillectomy hemorrhage rates in subjects receiving perioperative ketorolac and matched controls. Retrospective and prospective studies were both included. Methods PubMed search was performed for “[ketorolac OR toradol] AND tonsillectomy.” Articles fulfilling inclusion criteria were subjected to meta‐analysis to determine summary relative risk (RR). Results Adults are at five times increased risk for post‐tonsillectomy hemorrhage with ketorolac use (RR: 5.64; 95% confidence interval [CI]: 2.08–15.27; P < .001). In contrast, children under 18 are not at statistically significantly increased risk (RR: 1.39; 95% CI: 0.84–2.30; P = .20). Both retrospective and prospective studies yield consistent findings. There is no association of RR with pre‐ or postoperative administration of ketorolac. Conclusions Ketorolac can be used safely in children, but is associated with a five‐fold increased bleeding risk in adults. Level of Evidence NA Laryngoscope, 124:1789–1793, 2014