Same day discharge for pectus excavatum (PE) Is it possible? | 15 patients underwent | Nuss repair and enhanced recovery after surgery (ERAS) protocol was conducted | Prospective study | 2 Different Hospitals | June-September 2020 | Primary outcome | hospital length of stay (LOS) in hours | average 11.9 hours | 10 patients (66.7%) went home on postoperative day (POD) 0, and the rest went home on POD 1. | Secondary outcomes | same day discharge | postoperative complications | emergency department (ED) visits | return to the operating room (OR) | opioid use | No patients stayed in the hospital due to pain. | No patients were readmitted to the ED. | One patient had bar migration requiring return to the OR for revision. | Ten (66.7%) patients did not use opioids after discharge. | Conclusion: Same day discharge is feasible and safe in PE patients undergoing Nuss procedure with intercostal nerve cryoablation and intercostal nerve block. | https://doi.org/10.1016/j.jpedsurg.2021.02.007 | Source: Rettig RL et al. | Department of Pediatric Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States | @EmTombash | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Same day discharge for pectus excavatum—is it possible?
Infographic · Oct 2022 · 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 went home on operative day with adequate pain control, and 67% required no opioids post-discharge.
- Same-day discharge after Nuss procedure is feasible in 67% of pectus excavatum patients when combining intercostal nerve cryoablation with nerve block
- Pain was not a barrier to discharge; failures were due to urinary retention, drowsiness, vomiting, or anxiety—not inadequate analgesia
- Two-thirds of patients required no opioids after discharge when cryoablation and nerve blocks were used for pain control
- Average hospital stay was under 12 hours with enhanced recovery protocol; no ED readmissions occurred in this cohort
- Intercostal nerve cryoablation provides effective postoperative pain control without significant complications in pediatric chest wall surgery
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with icons including a calendar, ribcage diagram, house, patient in bed, clock, and medication bottles. Content is organized into sections with headers for study details, primary and secondary outcomes, key findings, and conclusion. Visual flow arrows connect the home icon to the clock, illustrating the discharge timeline.
R. Luke Rettig, Andrew G. Rudikoff,Hoi Yee Annie Lo, Constance W.Lee, Walter D. Vazquez, Karen Rodriguez, Donald B. Shaul, Antonio Hernandez Conte, Franklin M. Banzali, Roman M. Sydorak
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.