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Cryoablation is associated with shorter length of stay and reduced opioid use in pectus excavatum repair

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Abstract

Purpose

The use of intercostal nerve cryoablation (INC) is becoming increasingly common in patients undergoing pectus excavatum (PE) repair. This study sought to evaluate the use of INC compared to traditional use of thoracic epidural (TE).

Methods

A retrospective review of 79 patients undergoing PE repair with either INC or TE from May 2009 to December 2019 was conducted. The operations were performed by four surgeons who worked together at four different hospitals and have the same standardized practice. The primary outcome measure was hospital length of stay (LOS). Secondary variables included surgical time, total operating room time, operating room time cost, total hospital cost, inpatient opioid use, long-term opioid use after discharge, and postoperative complications.

Results

LOS decreased to 2.5 days in the INC group compared to 5 days in the TE group (p < 0.0001). Surgical time was increased in the INC group, but there was no difference in total OR time. The INC group experienced significantly lower hospital costs. Total hospital opioid administration was significantly lower in INC group, and there was a significant decrease in long-term opioid use in the INC group.

Conclusions

INC is a newer modality that decreases LOS, controls pain, and results in overall cost savings. We recommend that INC be included in the current practice for postoperative pain control in PE patients undergoing Nuss procedure.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd., Los Angeles, CA, 90027, USA

    R. Luke Rettig, Hoi Yee Annie Lo, Donald B. Shaul & Roman M. Sydorak

  2. Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd., Los Angeles, CA, 90027, USA

    Andrew G. Rudikoff, Franklin M. Banzali & Antonio Hernandez Conte

  3. Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Blvd, 3rd Floor, Los Angeles, CA, 90027, USA

    Roman M. Sydorak

Authors
  1. R. Luke Rettig
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  2. Andrew G. Rudikoff
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  3. Hoi Yee Annie Lo
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  4. Donald B. Shaul
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  5. Franklin M. Banzali
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  7. Roman M. Sydorak
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Contributions

RLR, AGR, HYL, DBS, AHC, and RMS conducted background research, conducted the study, and co-wrote/edited the manuscript. RLR and RMS also conducted the statistical analysis and interpreted the results.

Corresponding author

Correspondence to Roman M. Sydorak.

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The authors report no conflicts of interest.

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Rettig, R.L., Rudikoff, A.G., Lo, H.Y.A. et al. Cryoablation is associated with shorter length of stay and reduced opioid use in pectus excavatum repair. Pediatr Surg Int 37, 67–75 (2021). https://doi.org/10.1007/s00383-020-04778-x

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  • DOI: https://doi.org/10.1007/s00383-020-04778-x

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