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Intercostal Nerve Cryoablation Reduces Opioid Use and Length of Stay Without Increasing Adverse Events: A Retrospective Cohort Study of 5442 Patients Undergoing Surgical Correction of Pectus Excavatum.
Linton, Samuel C; Tian, Yao; Zeineddin, Suhail; Alayleh, Amin; De Boer, Chris; Goldstein, Seth D; Ghomrawi, Hassan M K; Abdullah, Fizan.
  • Linton SC; Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
  • Tian Y; Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
  • Zeineddin S; Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
  • Alayleh A; Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
  • De Boer C; Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
  • Goldstein SD; Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
  • Ghomrawi HMK; Departments of Surgery and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
  • Abdullah F; Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Ann Surg ; 279(4): 699-704, 2024 Apr 01.
Article en En | MEDLINE | ID: mdl-37791468
ABSTRACT

OBJECTIVE:

To examine differences in opioid use, length of stay, and adverse events after minimally invasive correction of pectus excavatum (MIRPE) with and without intercostal nerve cryoablation.

BACKGROUND:

Small studies show that intraoperative intercostal nerve cryoablation provides effective analgesia with no large-scale evaluations of this technique.

METHODS:

The pediatric health information system database was used to perform a retrospective cohort study comparing patients undergoing MIRPE at children's hospitals before and after the initiation of cryoablation. The association of cryoablation use with inpatient opioid use was determined using quantile regression with robust standard errors. Difference in risk-adjusted length of stay between the cohorts was estimated using negative binomial regression. Odds of adverse events between the two cohorts were compared using logistic regression with a generalized estimating equation.

RESULTS:

A total of 5442 patients underwent MIRPE at 44 children's hospitals between 2016 and 2022 with 1592 patients treated after cryoablation was introduced at their hospital. Cryoablation use was associated with a median decrease of 80.8 (95% CI 68.6-93.0) total oral morphine equivalents as well as a decrease in estimated median length of stay from 3.5 [3.2-3.9] days to 2.5 [2.2-2.9] days ( P value 0.016). Cryoablation use was not significantly associated with an increase in any studied adverse events.

CONCLUSIONS:

Introduction of cryoablation for perioperative analgesia was associated with decreased inpatient opioid use and length of stay in a large sample with no change in adverse events. This novel modality for perioperative analgesia offers a promising alternative to traditional pain management in thoracic surgery.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Criocirugía / Tórax en Embudo / Trastornos Relacionados con Opioides Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Child / Humans Idioma: En Año: 2024 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Criocirugía / Tórax en Embudo / Trastornos Relacionados con Opioides Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Child / Humans Idioma: En Año: 2024 Tipo del documento: Article