Highlights
- •Pain control is the main issue in the postoperative course of patients undergoing the Nuss procedure for pectus excavatum.
- •Compared to thoracic epidural, intercostal nerve cryoablation was associated with lower opioid use and shorter length of stay.
- •Intercostal nerve cryoablation is associated with increased operative time and increased hospitalization cost.
Summary
Background
Pectus excavatum is the most common congenital chest wall abnormality, with the Nuss
procedure being the most commonly performed repair. Pain control is the predominant
factor in the postoperative treatment of these patients. This study aims to compare
the cost and outcomes of intercostal nerve cryoablation (INC) and thoracic epidural
(TE) in patients undergoing the Nuss procedure.
Methods
A retrospective chart review was conducted at our institution for all patients who
underwent the Nuss procedure for pectus excavatum from 2002 to 2020. Patients were
stratified by pain management strategy, INC vs. TE. Chi-square and Fisher's exact
were used to compare categorical variables. Wilcoxon tests were used to evaluate continuous
variables and costs.
Results
A total of 158 patients were identified. Of these, 80.4% (N = 127) were treated with
epidural, while 19.6% (N = 31) were treated with intercostal nerve cryoablation. The
INC group had lower rates of PCA use (35.5% vs. 93.7%, p < 0.001), lower total morphine
milligram equivalent requirement (27.0 vs. 290.8, p < 0.001), and shorter length of
stay (3.2 days vs. 5.3 days, p < 0.001) compared to the TE group. INC was also associated
with longer operative times (153.0 min vs. 89.0 min, p < 0.001). The total hospitalization
cost for the INC group was higher compared to the TE group ($24,742.5 vs $21,621.9,
p = 0.001).
Conclusions
In patients undergoing the Nuss procedure, compared to thoracic epidural, INC was
associated with lower opioid use and shorter length of stay but at the cost of longer
operative time and increased hospitalization cost.
Level of evidence
Treatment Study, Level III.
Keywords
Abbreviations:
BMI (Body Mass Index), IQR (Interquartile Range), INC (Intercostal Nerve Cryoablation), MME (Morphine Milligram Equivalent), PCA (Patient Controlled Analgesia), TE (Thoracic epidural)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 22, 2022
Accepted:
December 15,
2022
Received:
December 14,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
