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Published on: February 11, 2022
Intercostal cryoablation during Nuss procedure: A large volume single surgeon's experience and outcomes
Raphael C Sun1, Steven C Mehl2, Centura R Anbarasu2
1Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States; Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
Insights
Intercostal cryoablation during the Nuss procedure reduces hospital stay and opioid use but increases the risk of slipped bars requiring reoperation. Further research is needed to balance these outcomes.
Area of Science:
- Thoracic surgery
- Pain management
- Pediatric surgery
Background:
- Intercostal cryoablation (IC) is increasingly used during the Nuss procedure for pectus excavatum.
- Previous studies suggest IC reduces hospital length of stay (LOS) and opioid consumption.
- The impact of IC on postoperative complications requires further investigation.
Purpose of the Study:
- To evaluate the association between intraoperative intercostal cryoablation (IC) and postoperative outcomes after the Nuss procedure.
- To compare patients who received IC with those who received other pain management modalities.
Main Methods:
- A single-center retrospective analysis of patients undergoing the Nuss procedure by one surgeon (2/2016-2/2020).
- Comparison of intraoperative IC versus non-IC pain management.
- Primary outcomes included postoperative complications, hospital LOS, and opioid administration.
- Multivariate analysis was used to assess outcomes.
Main Results:
- IC was associated with a significant decrease in hospital LOS (RC -1.91) and both hospital (RC -4.28) and discharge (RC -3.82) opioid administration.
- IC significantly decreased the odds of urinary retention (OR 0.16).
- However, IC was associated with a significant increase in the odds of slipped bars requiring reoperation (OR 36.65).
Conclusions:
- Intraoperative IC is an effective pain management strategy for the Nuss procedure, reducing LOS and opioid requirements.
- The use of IC is linked to a higher incidence of slipped bars necessitating reoperation.
- Surgeon experience may influence outcomes, highlighting the need for careful consideration of risks and benefits.
Background:
Recent studies have shown intercostal cryoablation(IC) during the Nuss procedure decreases hospital length of stay(LOS) and opioid administration. However, few studies have also evaluated the risk of postoperative complications related to IC.
Methods:
We performed a single center retrospective analysis of all patients who underwent Nuss procedure by one surgeon from 2/2016 to 2/2020, comparing intraoperative IC to other pain management modalities(non-IC). Primary outcomes were postoperative complications, hospital LOS, and opioid administration. Multivariate analysis was performed with outcomes reported as regression coefficients(RC) or odds ratios(OR) with 95% confidence interval.
Results:
IC was associated with decreased hospital LOS (RC -1.91[-2.29 to -1.54], less hospital opioid administration (RC -4.28[-5.13 to -3.43]), and less discharge opioid administration (RC -3.82[-5.23 to -2.41]). With respect to postoperative complications, IC decreased the odds of urinary retention (OR 0.16[0.06 to 0.44]); however, increased the odds of slipped bars requiring reoperation (OR 36.65[5.04-266.39]).
Conclusions:
Our single surgeon experience controls for surgeon variability and demonstrates intraoperative IC for the Nuss procedure is an effective pain management modality that decreases hospital LOS and opioid use during hospitalization and at discharge; however, it is associated with increased odds of slipped bars requiring reoperation.
Level Of Evidence:
III.
