Ketorolac, a pain medication, is underused in children operated on for bladder reflux
Ketorolac, a pain medication given to children who have been operated on for vesicoureteral reflux (VUR), is underutilized, concludes a new study. Only 52 percent of a group of 12,239 children operated on for VUR received ketorolac during their hospital stay. VUR is the abnormal flow of urine from the bladder back into the ureters. It is most commonly diagnosed in infancy and childhood after the patient has a urinary tract infection. Children with VUR may undergo surgical ureteral reimplantation (UR) for which there are a number of technical approaches. Regardless of surgical technique, however, many patients undergoing UR will experience postoperative pain and bladder spasm. Ketorolac, a nonsteroidal anti-inflammatory medication, has been shown in earlier studies to reduce postoperative pain and bladder spasm after UR, but it has been unclear whether pediatric urologists have widely adopted its use after UR.
Researchers examined patterns in ketorolac use and patient outcomes after UR in U.S. children's hospitals. Using a database of 40 children's hospitals, they identified 12,239 children who underwent UR between 2003 and 2008. Of these, 6,362 (52 percent) received ketorolac during their hospital stay. In comparison with patients who did not receive ketorolac, those receiving the drug had a shorter mean length of stay (2 vs. 3 days), decreased median hospital costs ($14,223 vs. $16,382), and similar complication rates (4 percent vs. 3 percent). Ketorolac use was independently associated with patient factors such as older age, female gender, and lower disease severity. The study was supported by the Agency for Healthcare Research and Quality (T32 HS00063).
See "Ketorolac is underutilized after ureteral reimplantation despite reduced hospital cost and reduced length of stay," by Jonathan C. Routh, M.D., M.P.H., Dionne A. Graham, Ph.D., and Caleb P. Nelson, M.D., M.P.H., in Urology 76(1), pp. 9-13, 2010.
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