Live Event Content · APSA - Is same day discharge possible following the Nuss repair for pectus excavatum - R. Luke Rettig
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Video7 min·Published May 2022Older

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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What the experts said27 expert statements
Pectus excavatum affects 1 in about 400 patients
EpidemiologicalLuke Reddick
Pectus excavatum has a male predominance at about a 4:1 ratio
EpidemiologicalLuke Reddick
The Nuss procedure is the gold standard for pectus excavatum fixation
GuidelineLuke Reddick
The Nuss procedure has been historically associated with a significant amount of pain leading to increased hospital lengths of stay and costs
ClinicalLuke Reddick
Intercostal nerve cryoablation has helped patients with pain and decreased length of stay
ClinicalLuke Reddick
Intercostal nerve cryoablation was performed at sites T3 through T7 on both sides of the chest
ClinicalLuke Reddick
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
ClinicalLuke Reddick
Bupivacaine was used proximal to the site of intercostal nerve cryoablation for the intercostal nerve block
ClinicalLuke Reddick
There were 15 patients in both study groups, all male
ClinicalLuke Reddick
Patient characteristics were similar in both groups with regards to Haller index, pectus correction index, age, and ethnicity
ClinicalLuke Reddick
Follow-up in the INB group was 7.5 months, whereas follow-up in the INC group was 29 months
ClinicalLuke Reddick
10 out of 15 patients in the INB group were discharged on postoperative day zero, with the remaining 5 discharged on postoperative day one
ClinicalLuke Reddick
None of the patients in the INC group were discharged prior to postoperative day 2
ClinicalLuke Reddick
Length of stay was decreased in the INB group at 12 hours compared to 58 hours in the INC group
ClinicalLuke Reddick
OR time was the same in both groups
ClinicalLuke Reddick
Cost was statistically significantly less in the INB group compared to the INC group
ClinicalLuke Reddick
Amount of opioids used were statistically significantly less in the INB group than the INC group
ClinicalLuke Reddick
10 patients in the INB group never used opioids after discharge, whereas the remaining 5 used them sparingly
ClinicalLuke Reddick
Zero patients in the INB group returned to the emergency department, whereas 4 in the INC group returned to the emergency department
ClinicalLuke Reddick
Medical devices typically are not subjected to the same rigorous, robust trials that drugs are
GuidelineVictor Garcia
Many adverse consequences for medical devices are either underreported or not reported, as suggested by Kaiser Health News
ClinicalVictor Garcia
Long-term consequences of cryoablation are unknown, particularly for children
OpinionVictor Garcia
There is concern about chronic neuropathic pain as a consequence of cryoablation
OpinionVictor Garcia
Long-term neuropathy rate with cryoablation is very low in their patient population
ClinicalLuke Reddick
Patients previously stayed 7, 8, or 9 days in the hospital with thoracic epidurals for Nuss procedure
ClinicalLuke Reddick
With introduction of intercostal nerve cryoablation, patients stayed in the hospital for 3 days
ClinicalLuke Reddick
High rates of neuropathy have not been observed in their patients with cryoablation
ClinicalLuke Reddick