APSA - Is same day discharge possible following the Nuss repair for pectus excavatum - R. Luke Rettig

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

Historically, the Nuss procedure has been 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 perioperative pain control

10 out of 15 patients in the intervention group (INB) were discharged on postoperative day zero, with the remaining 5 discharged on postoperative day one

None of the patients in the control group (INC) were discharged prior to postoperative day 2

Length of stay was decreased in the intervention group at 12 hours compared to 58 hours in the control group

Cost was statistically significantly less in the intervention group compared to the control group

Opioid use was statistically significantly less in the intervention group than the control group

10 patients in the intervention group never used opioids after discharge, while the remaining 5 used them sparingly

There was no difference between groups in complications including Foley catheter removal/replacement, pneumothorax requiring chest tube, infections (surgical site and UTI), and returns to urgent care

Zero patients in the intervention group returned to the emergency department, whereas 4 in the control group returned to the ED

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

The long-term consequences of cryoablation are unknown, particularly for children

There is concern about chronic neuropathic pain as a potential consequence of cryoablation

Long-term neuropathy rate following cryoablation is very low in the presenter's patient population

Before cryoablation, with thoracic epidurals, pectus patients would stay 7-9 days in the hospital

With introduction of intercostal nerve cryoablation, pectus patients were staying in the hospital for 3 days