Same day discharge for pectus excavatum—is it possible?
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Read the article on jpedsurg.org ↗Article · Feb 2021 · 1 min read
In brief
In brief
Prospective study of 15 patients demonstrates that same-day discharge after Nuss procedure for pectus excavatum is feasible when combining intercostal nerve cryoablation with nerve blocks and ERAS protocols. Two-thirds of patients were discharged on postoperative day 0 with adequate pain control, and 67% required no opioids after discharge.
Written by the GCMD Library team from the article.
Abstract
Purpose
The use of intercostal nerve cryoablation (INC) has been an effective modality for treating pain in patients undergoing pectus excavatum (PE) repair. This study sought to evaluate if PE patients undergoing Nuss procedures with INC and intercostal nerve block (INB) could safely be discharged the same day of surgery.
Methods
A prospective study with IRB approval of 15 consecutive patients undergoing PE Nuss repair with INC, INB, and an enhanced recovery after surgery (ERAS) protocol was conducted. The primary outcome measure was hospital length of stay (LOS) in hours. Secondary variables included same day discharge, postoperative complications, emergency department (ED) visits, urgent care (UC) visits, opioid use, and return to the operating room (OR).
Results
LOS averaged 11.9 h amongst 15 patients. Ten patients (66.7%) went home on postoperative day (POD) 0, and the rest went home on POD 1. No patients stayed in the hospital due to pain. Reasons for failure to discharge included urinary retention, drowsiness, vomiting, and anxiety, but not pain. No patients were readmitted to the ED. One patient visited UC for constipation. One patient had bar migration requiring return to the OR for revision. Ten (66.7%) patients did not use opioids after discharge.
Conclusions
Same day discharge is feasible and safe in PE patients undergoing Nuss procedure with INC and INB. INC with INB can adequately control pain without significant complications. Same day discharge can be safely considered for PE patients undergoing Nuss procedure with INC with INB.
Type of study
Prognosis study
Level-of-evidence rating
Level II