Perioperative Ketorolac Increases Post-Tonsillectomy Hemorrhage in Adults But Not Children

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.