APSA - Is same day discharge possible following the Nuss repair for pectus excavatum - R. Luke Rettig
With Dr. Luke Reddick & Dr. Victor Garcia · Live Event Content
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Pectus Excavatum 58 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Pectus excavatum affects 1 in about 400 patients
Pectus excavatum has a male predominance at about a 4:1 ratio
The Nuss procedure is the gold standard for pectus excavatum fixation
The Nuss procedure has been historically associated with a significant amount of pain leading to increased hospital lengths of stay and costs
Intercostal nerve cryoablation has helped patients with pain and decreased length of stay
Intercostal nerve cryoablation was performed at sites T3 through T7 on both sides of the chest
Patients have been in pain for about 24 hours after intercostal nerve cryoablation because it sometimes takes that long for the full effects to kick in
Bupivacaine was used proximal to the site of intercostal nerve cryoablation for the intercostal nerve block
There were 15 patients in both study groups, all male
Patient characteristics were similar in both groups with regards to Haller index, pectus correction index, age, and ethnicity
Follow-up in the INB group was 7.5 months, whereas follow-up in the INC group was 29 months
10 out of 15 patients in the INB group were discharged on postoperative day zero, with the remaining 5 discharged on postoperative day one
None of the patients in the INC group were discharged prior to postoperative day 2
Length of stay was decreased in the INB group at 12 hours compared to 58 hours in the INC group
OR time was the same in both groups
Cost was statistically significantly less in the INB group compared to the INC group
Amount of opioids used were statistically significantly less in the INB group than the INC group
10 patients in the INB group never used opioids after discharge, whereas the remaining 5 used them sparingly
Zero patients in the INB group returned to the emergency department, whereas 4 in the INC group returned to the emergency department
Medical devices typically are not subjected to the same rigorous, robust trials that drugs are
Many adverse consequences for medical devices are either underreported or not reported, as suggested by Kaiser Health News
Long-term consequences of cryoablation are unknown, particularly for children
There is concern about chronic neuropathic pain as a consequence of cryoablation
Long-term neuropathy rate with cryoablation is very low in their patient population
Patients previously stayed 7, 8, or 9 days in the hospital with thoracic epidurals for Nuss procedure
With introduction of intercostal nerve cryoablation, patients stayed in the hospital for 3 days
High rates of neuropathy have not been observed in their patients with cryoablation