BOB Ped Surg 2023 - Brittany Hegde, PAPS - Presentation

Minimally invasive repair of pectus excavatum is used to correct the most common thoracic anomaly in pediatric patients

Minimally invasive approach has been associated with decreased operative time, less blood loss and a quicker return to baseline compared to previous open approaches

MIRPE remains a painful procedure that historically required multiple adjuncts and a large amount of narcotics to achieve pain relief

A previous study at the institution found the use of cryo during minimally invasive repair lowered post-operative opioid use and hospital length of stay without increasing complications

Cryoablation is performed thoracoscopically using cryo nerve block probes under direct visualization

Probes are inserted via thoracoscopic port sites and activated at the site of intercostal nerves, usually bilaterally and within intercostal spaces three through seven

Cryo ablation subjects the intercostal nerves to extreme cold and is estimated to allow for pain control lasting weeks to months post ablation

Study included pediatric patients less than 18 from January 2011 to December 2021 who underwent minimally invasive repair

Cryo was introduced at the institution in November 2016 and every patient treated after this date received it

Total hospital cost data 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

Bayesian 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

The decrease in total cost is likely attributable to the impact of cryo use on hospital days

Cryo use was associated with a 100% probability of reduction in index hospital days compared to no cryo use

When comparing total hospital days including readmissions during 90 days, there was a 99% probability of total hospital days reduction with the use of cryo

The incidence of post-operative complications did not differ between treatment groups

Cryo use was associated with a 70% probability of reduction in post-operative complications compared to no cryo use