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Cryoablation in 350 Nuss procedures: Evolution of hospital length of stay and opioid use

Published:November 06, 2022DOI:https://doi.org/10.1016/j.jpedsurg.2022.10.051

      Highlights

      • What is currently known about this topic? – Studies show that intercostal cryoablation decreases length of stay and opioid use following the Nuss procedure for pectus excavatum.
      • What new information is contained in this article? – In the largest series to date, cryoablation is effective and decreases inpatient and discharge opioid requirement, while shortening length of stay. No increases in bar migration or neuropathic pain were seen.

      Abstract

      Introduction: Current studies show cryoablation decreases opioid requirements and lengths of stay (LOS) in patients undergoing the Nuss procedure for pectus excavatum. This study evaluated the relationship between cryoablation and clinical outcomes for the Nuss procedure.
      Methods: A retrospective single-center chart review was performed on patients undergoing the Nuss procedure with intercostal cryoablation from December 2017-August 2021. Demographics, hospital course, and postoperative complications were abstracted. To evaluate the evolution of outcomes over time, the earliest quarter (Q1) of cryoablation patients was compared to the last quarter (Q4).
      Results: Over 45 months, 350 Nuss procedures with cryoablation were performed. The mean age at operation was 15.7 ± 2.3 years with an average Haller Index of 5.4 ± 4.2. The mean operative time was 136 ± 40.5 minutes. On average, patients used 2.8 ± 2.5 OME/kg of opioid in hospital with a LOS of 2.7 ± 1.1 days. The Q4 patients were discharged 1.3 days earlier (p<0.05) than Q1 patients, with 80% of Q4 discharged by postoperative day #2 vs. 23% in Q1 (p<0.05). Q4 patients received 74% (p<0.05) less opioid in hospital and 21% (p<0.05) less on discharge. Within 90 days postoperatively, complication rates (chest tube placement, wound infection, readmission, neuropathic pain) were similar. Only two patients (0.6%) required reoperation for bar migration/slippage.
      Conclusion: With increased experience, cryoablation for the Nuss procedure decreased opioid use by 74% and was associated with 80% of patients achieving early discharge. Major complication rates were not increased. Cryoablation can be successfully implemented as an effective method of postoperative analgesia.
      Level of Evidence: Level III

      Graphical Abstract

      Keywords

      Abbreviations:

      LOS (length of stay), OME (oral morphine equivalent), PCA (patient-controlled analgesia)
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