Impact of Cryoanalgesia Use During Minimally Invasive Pectus Excavatum Repair on Hospital Days and Total Hospital Costs Among Pediatric Patients

Brittany N Hegde; Elenir Avritscher; Seyed A Arshad; Elisa I Garcia; Nutan B Hebballi; Maryam Broussard; KuoJen Tsao

doi:10.1016/j.jpedsurg.2023.02.036

Impact of Cryoanalgesia Use During Minimally Invasive Pectus Excavatum Repair on Hospital Days and Total Hospital Costs Among Pediatric Patients

J Pediatr Surg. 2023 Jul;58(7):1235-1238. doi: 10.1016/j.jpedsurg.2023.02.036. Epub 2023 Feb 17.

Authors

Brittany N Hegde¹, Elenir Avritscher², Seyed A Arshad³, Elisa I Garcia⁴, Nutan B Hebballi⁴, Maryam Broussard⁴, KuoJen Tsao³

Affiliations

¹ Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA. Electronic address: brittany.n.hegde@uth.tmc.edu.
² Department of Pediatrics, McGovern Medical School at University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 3.020, Houston, TX 77030, USA; Center for Clinical Research and Evidence Based Medicine, McGovern Medical School at University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.106, Houston, TX 77030, USA.
³ Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA.
⁴ Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA.

PMID: 36922280
DOI: 10.1016/j.jpedsurg.2023.02.036

Abstract

Introduction: Surgical repair of pectus excavatum is a painful procedure requiring multimodal pain control with historically prolonged hospital stay. This study aimed to evaluate the impact of cryoanalgesia during minimally invasive repair of pectus excavatum (MIRPE) on hospital days (HDs), total hospital costs (HCs), and complications. We hypothesized that cryoanalgesia would be associated with reduced HDs and total HCs with no increase in post-operative complications.

Methods: We conducted a retrospective review of pediatric patients who underwent MIRPE from 2011 to 2021. MIRPE details and post-operative outcomes within 90 days were abstracted. Total HDs included the index MIRPE admission and readmissions within 90 days. HCs were obtained from the hospital accounting system, retroactively adjusting for medical inflation. Bayesian generalized linear models with neutral prior assuming no effect were used. Differences between treatment groups were assessed using gamma distribution (HDs and HCs) and poisson (post-operative complications). All models used log link and controlled for age, gender, race, and Haller index.

Results: Forty-four patients underwent MIRPE during the study period. Cryoanalgesia was utilized in 29 (66%) patients. The probability of a reduction with cryoanalgesia vs. no cryoanalgesia was 99% for HDs (3.0 vs. 5.4 days; Bayesian RR: 0.6, 95% CrI: 0.5-0.8), 89% for HCs ($18,787 vs. $19,667; RR: 0.9, 95% CrI: 0.8-1.1), and 70% for postoperative complications (17% vs 33%; RR: 0.8, 95% CrI: 0.3-1.9).

Conclusion: Cryoanalgesia use in MIRPE likely reduced HDs, HCs, and post-operative complications. Further research is warranted to confirm these findings in large prospective studies.

Level of evidence: Level III.

Keywords: Cryoanalgesia; Hospital costs; Hospital days; Minimally invasive repair of pectus excavatum; Post-operative complications.

MeSH terms

Bayes Theorem
Child
Funnel Chest* / complications
Funnel Chest* / surgery
Hospital Costs
Hospitals
Humans
Minimally Invasive Surgical Procedures / methods
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Prospective Studies
Retrospective Studies