Same Day Discharge Following Minimally Invasive Repair of Pectus Excavatum

Pectus excavatum is surgically managed with minimally invasive bar placement. Pain control effectively determines the postoperative length of stay (LOS). Pain management after this operation has been transformed with the use of intercostal cryoablation, with LOS of one night being a previous standard of care. We developed a protocol with the ambition of allowing for same-day discharge (SDD).

A single-center, retrospective review of patients from August 2022 to August 2024 who underwent minimally invasive repair of pectus excavatum was performed. A protocol was initiated that involved early start times, pre-operative scopolamine patches and intra-operative ondansetron, hydromorphone, IV acetaminophen and ketorolac as well as thoracoscopic cryoablation for pain control. This cohort of patients was compared to patients managed in the year prior to implementation of this protocol which served as our control.

75 patients were managed during our study period as compared to 37 in our control group. Since initiation of our protocol, 46 (61.3 %) of the study group were discharged the day of surgery compared to 0 in the control group (P < 0.05). The median LOS in the study period was 18.2 h compared to 27 h in the control group (P < 0.05). The control group had 3 (8.1 %) patients return to the ER compared to 6 (7.9 %) in the study group. The control group patients were secondary to pain while the study group had 3 presentations for pain, 3 for pleural effusions requiring drainage, 1 for a subcutaneous abscess.

Same day discharge after pectus bar placement is safe and feasible without increased return to the hospital or readmission.