Ketorolac is Underutilized After Ureteral Reimplantation Despite Reduced Hospital Cost and Reduced Length of Stay
Received 25 August 2009; accepted 27 October 2009. published online 08 February 2010.
Objectives
To examine patterns of ketorolac use and its association with hospital outcomes. Although ureteral reimplantation (UR) reliably corrects vesicoureteral reflux, postoperative pain and bladder spasm often occur. Multiple studies show that ketorolac markedly reduces postoperative pain after UR, but there is no information on whether ketorolac is routinely used.
Methods
The Pediatric Health Information System is a national database collected by over 40 US children's hospitals. We identified children with primary vesicoureteral reflux who underwent UR between 2003 and 2008. Billing data were reviewed to identify patients who received ketorolac during hospitalization. Multivariate models were used to examine ketorolac use and postoperative outcomes including complication rates, length of stay, and hospital costs.
Results
We identified 12 239 children undergoing UR, 6362 (52%) of whom received ketorolac postoperatively. Factors associated with ketorolac use include older age, female gender, and decreased disease severity (all P <.0001). Ketorolac use was associated with reduced length of stay (2 vs 3 days, P <.0001) and decreased hospital costs ($14 223 vs $16 382, P <.0001). Complication rates were slightly higher in patients not receiving ketorolac (4% vs 3%). After adjusting for confounding factors, ketorolac use remained highly associated with decreased length of stay (P = .01) and decreased costs (P = .002), with no significant differences in complication rates (P = .4).
Conclusions
In a contemporary nationwide sample, only half of children undergoing UR received ketorolac. Ketorolac use is independently associated with reduced procedure costs and reduced length of stay after UR, without increased complications. This suggests underutilization of ketorolac after UR.
aDepartment of Urology, Children's Hospital Boston, Boston, Massachusetts
bHarvard Pediatric Health Services Research Fellowship Program, Harvard Medical School, Boston, Massachusetts
cClinical Research Program, Children's Hospital Boston, Boston, Massachusetts
Reprint requests: Caleb P. Nelson, M.D., M.P.H., Department of Urology, Children's Hospital Boston, 300 Longwood Ave, HU-359, Boston, MA 02115
J.C. Routh is supported by grant number T32-HS000063 from the Agency for Healthcare Research and Quality.
ABSTRACT