Another article you should know by Dr. Cecilia Gigena
"Cryoablation in 350 Nuss Procedures: Evolution of Hospital Length of Stay and Opioid Use"
Authors: Krista Lai, David M. Notrica, Lisa E. McMahon, Paul Kang, Mark S. Molitor, J. Craig Egan, Jae-O Bae, Zebediah M. Hunteman, Daniel J. Ostlie, Justin H. Lee, Benjamin E. Padilla
Full article: https://gcmd.co/3M28m8k
Introduction
Current studies show cryoablation decreases opioid requirements and lengths of stay (LOS) in patients undergoing the Nuss procedure for pectus excavatum. This study evaluated the relationship between cryoablation and clinical outcomes for the Nuss procedure.
Methods
A retrospective single-center chart review was performed on patients undergoing the Nuss procedure with intercostal cryoablation from December 2017-August 2021. Demographics, hospital course, and postoperative complications were abstracted. To evaluate the evolution of outcomes over time, the earliest quarter (Q1) of cryoablation patients was compared to the last quarter (Q4).
Results
Over 45 months, 350 Nuss procedures with cryoablation were performed. The mean age at operation was 15.7 ± 2.3 years with an average Haller Index of 5.4 ± 4.2. The mean operative time was 136 ± 40.5 minutes. On average, patients used 2.8 ± 2.5 OME/kg of opioid in hospital with a LOS of 2.7 ± 1.1 days. The Q4 patients were discharged 1.3 days earlier (p<0.05) than Q1 patients, with 80% of Q4 discharged by postoperative day #2 vs. 23% in Q1 (p<0.05). Q4 patients received 74% (p<0.05) less opioid in hospital and 21% (p<0.05) less on discharge. Within 90 days postoperatively, complication rates (chest tube placement, wound infection, readmission, neuropathic pain) were similar. Only two patients (0.6%) required reoperation for bar migration/slippage.
Conclusion
With increased experience, cryoablation for the Nuss procedure decreased opioid use by 74% and was associated with 80% of patients achieving early discharge. Major complication rates were not increased. Cryoablation can be successfully implemented as an effective method of postoperative analgesia.
Type: video · 0 min · posted 2023-10-18 Canonical: https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334 ## Chapters - [0:00](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=0) Cryoanalgesia Experience Curve in Nuss Procedures ## Statements - "The study was a retrospective single institution study conducted in Phoenix from 2017 to 2021" — Cecilia Gigena (clinical) [0:10](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=10) - "The study compared patients who underwent Nuss procedure with cryoanalgesia in the first quarter of institutional experience versus the fourth quarter" — Cecilia Gigena (clinical) [0:16](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=16) - "350 patients underwent Nuss procedure with cryoanalgesia in the study period" — Cecilia Gigena (epidemiological) [0:29](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=29) - "Patients in the last quarter were discharged 1.3 days earlier than patients in the first quarter" — Cecilia Gigena (clinical) [0:34](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=34) - "Patients in the last quarter required 74% less opioids compared to the first quarter" — Cecilia Gigena (clinical) [0:34](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=34) - "Experience plays a role in cryoanalgesia outcomes for Nuss procedures" — Cecilia Gigena (opinion) [0:46](https://library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=46) ## Transcript Do you use cryo for the NAS procedure? Hi, I'm Cecilia Jigena from Cincinnati Children's Hospital, and I think this is an article that you should know about. This is a retrospective single institution study done in Phoenix from 2017 to 2021. And their aim was to compare patients that underwent NAS procedure with cryoanalgesia in the 1st quarter of their experience with the 4th quarter of their experience, and what did they find? They had 350 patients that underwent NAS procedure with cryo analgesia. And what they found is that patients in the last quarter were discharged 1.3 days earlier than patients in the first quarter and also requires 74% less opioids. So it seems that experience really plays a role talking about cryoathesia. Let us know what you think and stay tuned for more articles that you should know about. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai