Our Summary

This research paper examines the impact of a drug called ketorolac on children who have had their appendix removed. Some recent studies on adults have suggested that ketorolac might lead to more complications after stomach surgeries, so this study wanted to see if the same was true for children having an appendectomy.

The study looked at data from nearly 79,000 patients aged 5-17 who had their appendix removed between 2010-2014. The researchers made sure to exclude any patients who had their appendix removed as part of another procedure, those with other health issues, and those who died or needed a specific type of life support. The researchers recorded a lot of information about these patients, including their age, sex, race, whether they ended up in intensive care or needed a ventilator, and whether their appendicitis was complicated or not. They also looked at whether the patients received ketorolac on the day of or the day after their surgery.

The main things the researchers were interested in were whether there were any surgical complications during the patient’s hospital stay, how long the patient had to stay in the hospital after the surgery, how much the hospital visit cost, whether the patient had to go back to the hospital within 30 days, and whether the patient had to go back to the hospital because of an infection or because they needed more fluid drained from their belly.

Most of the patients (73%) received ketorolac after their surgery, and those with complicated appendicitis were more likely to get the drug. About 2.6% of the patients had a surgical complication during their hospital stay, 4.3% had to go back to the hospital within 30 days, and 2% had an infection or needed more fluid drained from their belly after the surgery.

The study found that giving ketorolac to patients after their appendectomy was linked to a decrease in surgical complications and a decrease in costs (by about $459 on average). However, it was not linked to the patient having to go back to the hospital, the length of the hospital stay after the surgery, or a post-surgery infection.

In conclusion, this study suggests that giving ketorolac to children after an appendectomy is common and does not seem to lead to longer hospital stays, infections, or a need to return to the hospital. However, it does seem to be linked to fewer overall complications after surgery and lower costs.

FAQs

  1. What is the impact of ketorolac on children who have had an appendectomy?
  2. Does the administration of ketorolac after an appendectomy lead to more complications or longer hospital stays?
  3. Can the use of ketorolac after appendectomy surgery reduce overall complications and lower costs?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pediatric appendectomy is to discuss with the healthcare team the use of pain medications like ketorolac after the surgery. This study suggests that ketorolac can help reduce surgical complications and costs for children undergoing an appendectomy. It’s important for the patient and their family to have an open conversation with the medical team about the benefits and potential risks of using this medication during the recovery process.

Suitable For

Patients who are typically recommended pediatric appendectomy are those who have acute appendicitis, which is the most common reason for appendectomy in children. This condition is characterized by inflammation of the appendix, often due to a blockage in the appendix leading to bacterial infection. Symptoms of acute appendicitis include abdominal pain, fever, nausea, and vomiting.

In some cases, children with complicated appendicitis may also require surgery. Complicated appendicitis occurs when the appendix has ruptured or formed an abscess, leading to more severe symptoms and potential complications. These patients may require a more urgent appendectomy to prevent further complications such as peritonitis or sepsis.

Overall, pediatric appendectomy is recommended for children who have been diagnosed with acute or complicated appendicitis and are experiencing symptoms that indicate the need for surgical intervention. The decision to perform an appendectomy in children is typically made based on a thorough evaluation of the patient’s symptoms, physical examination, and imaging studies such as ultrasound or CT scan.

Timeline

Before pediatric appendectomy:

  • Patient experiences symptoms of appendicitis, such as abdominal pain, nausea, vomiting, and fever.
  • Patient undergoes medical evaluation by a healthcare provider, which may include physical examination, blood tests, and imaging studies (such as ultrasound or CT scan).
  • Diagnosis of appendicitis is confirmed, and the decision is made to perform an appendectomy.
  • Patient and/or guardian receive information about the surgery, risks, and potential complications.

After pediatric appendectomy:

  • Patient undergoes surgery to remove the inflamed appendix.
  • Patient is monitored in the hospital for any surgical complications.
  • Patient may receive pain medication, antibiotics, and fluids to aid in recovery.
  • Patient is discharged from the hospital once stable and able to tolerate food and drink.
  • Patient may experience some pain and discomfort at the surgical site as they recover at home.
  • Patient follows up with their healthcare provider for a post-operative check-up to ensure proper healing.
  • Patient resumes normal activities and diet as instructed by their healthcare provider.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pediatric appendectomy and the use of ketorolac include:

  1. What are the potential benefits of using ketorolac after my child’s appendectomy?
  2. Are there any potential risks or side effects associated with giving ketorolac to children after surgery?
  3. How will the decision to use ketorolac be made for my child, and what factors will be considered?
  4. Will my child receive ketorolac on the day of the surgery, the day after, or both?
  5. How will the use of ketorolac impact the recovery process for my child?
  6. What other pain management options are available for my child after their appendectomy?
  7. Will giving ketorolac to my child affect the likelihood of surgical complications, hospital readmission, or infections post-surgery?
  8. How will the use of ketorolac affect the overall cost of my child’s hospital stay and treatment?
  9. Are there any specific guidelines or precautions that should be followed if my child is given ketorolac after their surgery?
  10. Can you provide more information or resources for me to learn about the use of ketorolac in pediatric appendectomies?

Reference

Authors: Naseem HU, Dorman RM, Ventro G, Rothstein DH, Vali K. Journal: J Surg Res. 2017 Oct;218:232-236. doi: 10.1016/j.jss.2017.05.087. Epub 2017 Jun 21. PMID: 28985855