BOB Ped Surg 2023 - Brittany Hegde, PAPS - Presentation

Hello. My name is Britney Hegdy and I will be presenting on the impact of cryo analgesia use during minimally invasive repair of pectus excavatum on total hospital costs on behalf of my co-authors. I have nothing to disclose. Minimally invasive repair of pectus excavatum is used to correct the most common thoracic anomaly in pediatric patients. This minimally invasive approach has been associated with decreased operative time, less blood loss and a quicker return to baseline compared to previous open approaches. Despite these improvements, it remains a painful procedure that historically required multiple adjuncts and a large amount of narcotics to achieve pain relief. A previous study at our institution found the use of cryo during minimally invasive repair lowered post-operative opioid use in hospital length of stay without increasing complications. Cryoablation at our institution is performed thoracoscopically using cryo nerve block probes and performed under direct visualization. The probes are inserted via thoracoscopic port sites and activated at the site of intercostal nerves, usually bilaterally and within intercostal spaces three through seven. The cryo ablation subjects the intercostal nerves to extreme cold and is estimated to allow for pain control lasting weeks to months post ablation. This study aimed to evaluate the impact of cryo use during minimally invasive repair on total hospital cost. We also aimed to look at the impact on hospital days and post-operative complications. 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. We performed a retrospective pre-post study evaluating pediatric patients less than 18 from January 2011 to December 2021 who underwent minimally invasive repair. Cryo was introduced at our institution in November 2016 and every patient treated after this date received it. Patients were divided into treatment groups based on if they received cryo or not during repair. Demographic information, operative details and post-operative complications within 90 days were collected from the EMR. Total hospital cost data was obtained from our hospital accounting department and was adjusted for inflation by the consumer price index for medical services. Of the 44 patients included, 29, 65.9% received cryo during minimally invasive repair. A greater percentage in both treatment groups were male. Both treatment groups were similar regarding age, height, weight, insurance status, race, symptoms at presentation and Haller index. Basian models were used to analyze the impact of cryo on various outcomes utilizing a neutral prior assuming no treatment effect. Cryo 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 despite the additional equipment needed to perform cryo ablation. This decrease in total cost is likely attributable to the impact of cryo use on hospital days. When looking at hospital days within the index admission, cryo use was associated with a 100% probability of reduction in index hospital days compared to no cryo use. Likewise, when comparing total hospital days, which included the patient's index admission plus any readmission during 90 days, there was a 99% probability of total hospital days reduction with the use of cryo use. The incidence of post-operative complications did not differ between treatment groups. When analyzed with Baan models, cryo use was associated with a 70% probability of reduction in post-operative complications compared to no cryo use. In conclusion, cryo use was likely uh reduced total hospital costs, as well as reduced hospital days and post-operative complications. Given the limited sample size within our single institution data, future larger multicenter studies are needed to further validate these findings. Thank you.