We hypothesized that cryo use would be associated with a decrease in total hospital costs, as well as a decrease in hospital days with no increase in post-operative complications.
Despite these improvements, it remains a painful procedure that historically required multiple adjuncts and a large amount of narcotics to achieve pain relief.
BOB Ped Surg 2023 - Brittany Hegde, PAPS - Presentation
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clinicalMinimally invasive repair of pectus excavatum is used to correct the most common thoracic anomaly in pediatric patients↗
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quoteMinimally invasive repair of pectus excavatum is used to correct the most common thoracic anomaly in pediatric patients.↗
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clinicalA previous study at the institution found the use of cryo during minimally invasive repair lowered post-operative opioid use and hospital length of stay without increasing complications↗
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clinicalMinimally invasive approach has been associated with decreased operative time, less blood loss and a quicker return to baseline compared to previous open approaches↗
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clinicalMIRPE remains a painful procedure that historically required multiple adjuncts and a large amount of narcotics to achieve pain relief↗
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quoteDespite these improvements, it remains a painful procedure that historically required multiple adjuncts and a large amount of narcotics to achieve pain relief.↗
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clinicalProbes are inserted via thoracoscopic port sites and activated at the site of intercostal nerves, usually bilaterally and within intercostal spaces three through seven↗
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clinicalCryo ablation subjects the intercostal nerves to extreme cold and is estimated to allow for pain control lasting weeks to months post ablation↗
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clinicalCryoablation is performed thoracoscopically using cryo nerve block probes under direct visualization↗
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quoteThe cryo ablation subjects the intercostal nerves to extreme cold and is estimated to allow for pain control lasting weeks to months post ablation.↗
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quoteWe hypothesized that cryo use would be associated with a decrease in total hospital costs, as well as a decrease in hospital days with no increase in post-operative complications.↗
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epidemiologicalStudy included pediatric patients less than 18 from January 2011 to December 2021 who underwent minimally invasive repair↗
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clinicalTotal hospital cost data was adjusted for inflation by the consumer price index for medical services↗
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clinicalCryo was introduced at the institution in November 2016 and every patient treated after this date received it↗
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quoteCryo was introduced at our institution in November 2016 and every patient treated after this date received it.↗
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epidemiologicalA greater percentage in both treatment groups were male↗
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epidemiologicalOf the 44 patients included, 29 (65.9%) received cryo during minimally invasive repair↗
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epidemiologicalBoth treatment groups were similar regarding age, height, weight, insurance status, race, symptoms at presentation and Haller index↗
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clinicalCryo use was associated with a 100% probability of reduction in index hospital days compared to no cryo use↗
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clinicalBayesian models were used to analyze the impact of cryo on various outcomes utilizing a neutral prior assuming no treatment effect↗
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clinicalCryo use was associated with an 89% probability of total hospital cost reduction compared to no cryo use with a difference in total cost of $880↗
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clinicalWhen comparing total hospital days including readmissions during 90 days, there was a 99% probability of total hospital days reduction with the use of cryo↗
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opinionThe decrease in total cost is likely attributable to the impact of cryo use on hospital days↗
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clinicalCryo use was associated with a 70% probability of reduction in post-operative complications compared to no cryo use↗
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clinicalThe incidence of post-operative complications did not differ between treatment groups↗
