title: Ketorolac after congenital heart surgery: does it increase the risk of significant bleeding complications?
abstract: BACKGROUND
  The routine use of ketorolac after congenital heart surgery in infants and children is limited by concerns for postoperative bleeding complications. The object of this study was to determine if the use of ketorolac is associated with an increased risk of significant postoperative bleeding after congenital heart surgery in infants and children.
  
  
  METHODS
  A retrospective chart review was performed. The exposure of interest was postoperative use of ketorolac after congenital heart surgery in infants and children. The outcome measured was postoperative bleeding requiring surgical exploration. The patients who received ketorolac were compared with an age- and diagnosis-matched comparison group who did not receive ketorolac.
  
  
  RESULTS
  Records of 842 infants and children who underwent congenital heart surgery between July 2001 and October 2002 were reviewed. 94 (11.1%) patients were treated with ketorolac postoperatively. The comparison group consisted of 94 matched subjects selected from the patients that did not receive ketorolac. The mean age of patient in the ketorolac group was 8.5 (+/-6.1) years. No (0%) patients in the ketorolac group and four (4.2%) patients in the nonketorolac group developed postoperative bleeding requiring surgical exploration. The relative risk for postoperative bleeding that required surgical exploration in the ketorolac group compared with the nonketorolac group was 0.2 (95% CI 0.02-1.67).
  
  
  CONCLUSIONS
  The use of ketorolac after congenital heart surgery in infants and children does not significantly increase the risk of bleeding complications requiring surgical exploration.
authors.affiliation: Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA. doctoranuja@yahoo.com
authors.forename: Anuja
authors.initials: A
authors.lastname: Gupta
authors.forename: Casey
authors.initials: C
authors.lastname: Daggett
authors.forename: Joseph
authors.initials: J
authors.lastname: Ludwick
authors.forename: Winfield
authors.initials: W
authors.lastname: Wells
authors.forename: Alan
authors.initials: A
authors.lastname: Lewis
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D020910:Ketorolac / Q000009:adverse effects* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac