Intercostal cryoablation during Nuss procedure: A large volume single surgeon's experience and outcomes
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In brief
In brief
Single-surgeon retrospective study (2016-2020) demonstrates that intercostal cryoablation during Nuss procedure significantly reduces hospital stay, opioid use, and urinary retention compared to standard pain management. However, cryoablation was associated with a 37-fold increased risk of bar slippage requiring reoperation, suggesting a trade-off between improved pain control and mechanical stability.
Written by the GCMD Library team from the article.
Abstract
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