Intercostal nerve cryoablation is associated with lower hospital cost during minimally invasive Nuss procedure for pectus excavatum.

Autor: Aiken TJ; Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI, USA 53792., Stahl CC; Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI, USA 53792., Lemaster D; Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI, USA 53792., Casias TW; Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, USA 53792., Walker BJ; Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, USA 53792., Nichol PF; Division of Pediatric Surgery, Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI, USA 53792., Leys CM; Division of Pediatric Surgery, Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI, USA 53792., Abbott DE; Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI, USA 53792., Brinkman AS; Division of Pediatric Surgery, Department of Surgery, University of Wisconsin Hospitals and Clinics, 600 Highland Ave, Madison, WI, USA 53792. Electronic address: brinkman@surgery.wisc.edu.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2021 Oct; Vol. 56 (10), pp. 1841-1845. Date of Electronic Publication: 2020 Oct 19.
DOI: 10.1016/j.jpedsurg.2020.10.009
Abstrakt: Minimally invasive repair of pectus excavatum (Nuss procedure) is associated with significant pain, and efforts to control pain impact resource utilization. Bilateral thoracic intercostal nerve cryoablation has been proposed as a novel technique to improve post-operative pain control, though the impact on hospital cost is unknown.
Methods: We conducted a retrospective study of patients undergoing a Nuss procedure from 2016 to 2019. Patients who received cryoablation were compared to those that received traditional pain control (patient-controlled analgesia or epidural). Outcome variables included postoperative opioid usage (milligram morphine equivalents, MME), length of stay (LOS), and hospital cost.
Results: Thirty-five of 73 patients studied (48%) received intercostal nerve cryoablation. LOS (1.0 vs 4.0 days, p < 0.01) and total hospital cost ($21,924 versus $23,694, p = 0.04) were decreased in the cryoablation cohort, despite longer operative time (152 vs 74 min, p < 0.01). Cryoablation was associated with decreased opioid usage (15.0 versus 148.6 MME, p < 0.01) during the 24 h following surgery and this persisted over the entire postoperative period, including discharge opioid prescription (112.5 vs 300.0 MME, p < 0.01).
Conclusion: Bilateral intercostal nerve cryoablation is associated with decreased postoperative opioid usage and decreased resource utilization in pediatric patients undergoing a minimally invasive Nuss procedure for pectus excavatum.
Level of Evidence: Retrospective comparative study, level III.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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