Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
Urology. 2010 Jul;76(1):9-13. doi: 10.1016/j.urology.2009.10.062. Epub 2010 Feb 6.
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.
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.
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).
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.
研究酮咯酸的使用模式及其与医院结局的关系。尽管输尿管再植术（UR）能可靠地纠正膀胱输尿管反流，但术后疼痛和膀胱痉挛常发生。多项研究表明酮咯酸能显著减轻 UR 后的术后疼痛，但关于其是否常规使用尚无信息。
儿科健康信息系统是一个由 40 多家美国儿童医院收集的全国性数据库。我们确定了 2003 年至 2008 年间接受 UR 的原发性膀胱输尿管反流患儿。对计费数据进行了审查，以确定住院期间接受酮咯酸治疗的患者。使用多变量模型来检查酮咯酸的使用情况以及术后结局，包括并发症发生率、住院时间和住院费用。
我们共确定了 12239 例行 UR 的儿童，其中 6362 例（52%）术后接受了酮咯酸。与使用酮咯酸相关的因素包括年龄较大、女性和疾病严重程度降低（均 P <.0001）。使用酮咯酸与住院时间缩短（2 天 vs 3 天，P <.0001）和住院费用降低（14223 美元 vs 16382 美元，P <.0001）相关。未使用酮咯酸的患者并发症发生率略高（4% vs 3%）。在调整混杂因素后，使用酮咯酸与住院时间缩短（P =.01）和费用降低（P =.002）高度相关，并发症发生率无显著差异（P =.4）。
在当代全国性样本中，只有一半接受 UR 的儿童接受了酮咯酸。酮咯酸的使用与 UR 后手术成本降低和住院时间缩短独立相关，且不会增加并发症。这表明 UR 后酮咯酸的使用不足。
