Same day discharge for pectus excavatum-is it possible?

Area of Science:

• Pain Management
• Thoracic Surgery
• Surgical Outcomes

Background:

• Pectus excavatum (PE) repair, particularly the Nuss procedure, often involves significant postoperative pain.
• Intercostal nerve cryoablation (INC) and intercostal nerve block (INB) are established pain management techniques for PE surgery.
• Enhanced Recovery After Surgery (ERAS) protocols aim to optimize patient recovery and reduce hospital length of stay.

Purpose of the Study:

• To evaluate the feasibility and safety of same-day discharge for PE patients undergoing the Nuss procedure with INC and INB.
• To assess the impact of INC and INB on postoperative pain control and complications in PE patients.

Main Methods:

• Prospective study of 15 consecutive PE patients undergoing Nuss repair with INC, INB, and an ERAS protocol.
• Primary outcome: hospital length of stay (LOS) in hours.
• Secondary outcomes: same-day discharge rates, postoperative complications, ED/UC visits, opioid use, and return to OR.

Main Results:

• Average LOS was 11.9 hours.
• 66.7% of patients were discharged on postoperative day 0.
• No patients were hospitalized due to pain; complications like urinary retention or drowsiness, not pain, led to delayed discharge in some cases.
• 66.7% of patients did not require opioids post-discharge.

Conclusions:

• Same-day discharge is a safe and feasible option for PE patients undergoing Nuss procedures with INC and INB.
• INC combined with INB provides effective pain control with minimal complications.
• Early discharge can be safely considered for PE patients managed with this multimodal pain approach.