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.
Keywords: Abbreviations; Forced expiratory volume (FEV); Forced vital capacity (FVC); Haller index (HI); Intercostal cryoablation; Nuss; Opioid; Pectus excavatum; intercostal cryoablation (IC); interquartile ranges (IQR); length of stay (LOS); multiple polyester (p-dioxanone) sutures (PDS); odds ratio (OR); oral morphine equivalents (OME/kg); patient-controlled analgesia (PCA); peripheral nerve block (PNB); regression coefficient (RC); thoracic epidural (TE).
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