Opioid Prescriptions at Discharge After Minimally Invasive Repair of Pectus Excavatum Are Reduced With Cryoablation
R Scott Eldredge1, Brielle Ochoa2, Jared Carmichael2
1Division of Pediatric Surgery, Department of Surgery, Phoenix Children's, Phoenix, AZ, USA; Department of Surgery, Mayo Clinic School of Medicine and Science, Phoenix, AZ, USA.
Background:
The minimally invasive repair of pectus excavatum (MIRPE) is associated with significant postoperative pain and opioid use. The objective of this study was to determine the effect of intercostal nerve cryoablation (Cryo) on inpatient and post-hospital opioid prescription practices following MIPRE.
Methods:
A retrospective review at a single pediatric center was conducted of patients ≤21 years old who underwent MIRPE. Oral morphine equivalents (OME) of inpatient and discharge opioids were compared between Cryo and no-Cryo cohorts.
Results:
579 patients were identified (82.8% male, mean age 15.4 ± 2.0 years). Cryo was performed in 73.5% of patients. The total inpatient OME use was less in the Cryo group (0.89 ± 0.68 vs. 1.6 ± 0.5 OME/kg/day; p < 0.001). Patients who underwent Cryo were prescribed significantly less OME at discharge compared to the no-Cryo group (3.9 ± 1.7 vs. 10.0 ± 4.1 OME mg/kg, p < 0.001). There was no statistically significant difference in the proportion of patients who required an opioid prescription refill (Cryo 12.4% vs. no-Cryo 11.5%, p = 0.884) or were readmitted (Cryo 5.3% vs. no-Cryo 4.6%, p = 0.833).
Conclusion:
Patients who underwent cryoablation during MIRPE were prescribed significantly less opioid at the time of discharge without increasing the need for opioid refills or hospital readmissions.
Level Of Evidence:
Treatment study; Level III evidence.
Insights
Intercostal nerve cryoablation during minimally invasive repair of pectus excavatum (MIRPE) significantly reduces inpatient and discharge opioid use. This pain management technique did not increase opioid refills or readmissions, offering a safer approach for pediatric patients.
Area of Science:
- Thoracic surgery
- Pediatric surgery
- Pain management
Background:
- Minimally invasive repair of pectus excavatum (MIRPE) is linked to substantial postoperative pain and opioid consumption.
- Effective pain management strategies are crucial to improve patient outcomes after MIRPE.
Purpose of the Study:
- To evaluate the impact of intercostal nerve cryoablation (Cryo) on opioid prescribing patterns in patients undergoing MIRPE.
- To compare inpatient and post-hospital opioid use between patients who received cryoablation and those who did not.
Main Methods:
- Retrospective review of patients aged ≤21 years who underwent MIRPE at a single pediatric center.
- Comparison of oral morphine equivalents (OME) for inpatient and discharge opioid prescriptions between cryoablation (Cryo) and no-cryo cohorts.
Main Results:
- Patients who underwent cryoablation (73.5%) had significantly lower total inpatient OME use (0.89 vs. 1.6 OME/kg/day) and were prescribed less OME at discharge (3.9 vs. 10.0 OME mg/kg).
- No significant differences were observed in the rates of opioid prescription refills (12.4% vs. 11.5%) or hospital readmissions (5.3% vs. 4.6%) between the groups.
Conclusions:
- Intercostal nerve cryoablation during MIRPE effectively reduces opioid requirements at discharge.
- Cryoablation is a safe adjunct to MIRPE, as it does not increase the need for opioid refills or hospital readmissions.
