Six Years of Quality Improvement in Pectus Excavatum Repair | Single institution | Retrospective cohort study | Oct 2017 to Sep 2023 | 62 patients | Epidurals (n=15) | Cryoablation (n=18) | Cryoablation + ERAS (n=29) | Cryoablation was associated with | 62.3% decrease in length of stay (p < 0.001) | 86.6% decrease in inpatient morphine mg equivalents (p < 0.001) | 72.9% decrease in discharge opioids (p < 0.001) | 24.5% longer operative times (p = 0.02) | 46.4% higher post-op day one pain scores (p = 0.04) | Conclusion: Over six years, cryoablation and ERAS protocols reduced length of stay and opioid use, improving outcomes without compromising patient experience. | https://pubmed.ncbi.nlm.nih.gov/39117536/ | Rook JM et al. | Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA | @EmGooteeMD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Six Years of Quality Improvement in Pectus Excavatum Repair: Implementation of Intercostal Nerve Cryoablation and ERAS Protocols for Patients Undergoing Nuss Procedure
Infographic · Mar 2025 · 1 min read
In brief
In brief
Six-year quality improvement study demonstrates that intercostal nerve cryoablation reduced hospital stay by 62% and opioid use by 87% in Nuss procedure patients. Adding ERAS protocols further decreased discharge opioids by 83% and postoperative pain scores by 25%, suggesting synergistic benefits of combined approaches.
- Intercostal nerve cryoablation reduced hospital stay by 62%, inpatient opioids by 87%, and discharge opioids by 73% after Nuss procedure.
- Cryoablation increased operative time by 25% and POD1 pain scores by 46%, requiring additional pain management optimization.
- Adding ERAS protocol to cryoablation further decreased discharge opioids by 83% and reduced POD1 pain scores by 25%.
- Combined cryoablation and ERAS protocols significantly improved outcomes without compromising patient experience in pectus repair.
- Protocolized multimodal pain management can synergistically reduce opioid exposure and length of stay in pediatric chest wall surgery.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and gray color scheme with anatomical illustrations of a ribcage and calendar icon. Green arrows point downward to highlight positive outcomes (decreased metrics), while red arrows point upward for negative outcomes (increased metrics). A prescription bottle illustration appears in the lower right corner.
Jordan M. Rook, Lisa K. Lee, Justin P. Wagner, Veronica F. Sullins, Steven L. Lee, Shant Shekherdimian, Daniel A. DeUgarte, Christine E. Dichter, Howard C. Jen
Background: The Nuss procedure for pectus excavatum is associated with prolonged hospitalizations due to pain. We evaluated implementation of intercostal nerve cryoablation and enhanced recovery after surgery (ERAS) protocols on outcomes of Nuss procedures performed over six years at a single institution.
Methods: This retrospective cohort study included patients who underwent Nuss procedure from 10/2017 to 09/2023. Patients received epidurals prior to 06/2019, cryoablation from 06/2019 to 07/2021, and ERAS with cryoablation and intraoperative methadone administration after 07/2021. We used multivariable linear regression to evaluate length of stay (LOS), inpatient morphine milligram equivalents (MMEs), and discharge opioids. We assessed the balancing measures of operative time, postoperative pain scores, and complications.
Results: We identified 62 patients; 15 who received epidurals, 18 cryoablation, and 29 cryoablation with ERAS. Cryoablation was associated with a 62.3% (p < 0.001) decrease in length of stay, an 86.6% (p < 0.001) decrease in inpatient MMEs, and a 72.9% (p < 0.001) decrease in discharge opioids. Cryoablation was additionally associated with 24.5% (p = 0.02) longer operative times and 46.4% (p = 0.04) higher postoperative day one pain scores. Subsequent implementation of an ERAS protocol was associated with a further 82.8% (p = 0.04) decrease in discharge opioids and a 25.0% (p = 0.04) decrease in postoperative day one pain scores.
Conclusions: Over six years of quality improvement efforts, we found the implementation of cryoablation and ERAS protocols to be associated with a significant decrease in length of stay and opioid exposures. Protocolized pain management and cryoablation may work synergistically to improve outcomes without compromising patient experience.