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BOB Ped Surg 2023 - Joshua Ramjist, CAPS - Presentation
With Dr. Joshua Ramjist
Part of
Pectus Excavatum 58 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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Criteria for Pectus Repair: Update Course 2015
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Pectus-Patient Testimonial and Experience
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Patient Testimonial and Experience: Pectus Innovations
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Cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure
1 min · Published Oct 2023
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What the experts said
Pectus excavatum is the most common congenital chest deformity
Pectus excavatum affects one in 400 births
Pectus excavatum affects patients at a vulnerable time in their lives in the childhood and adolescent years
The Nuss procedure has been revolutionary in correcting pectus excavatum deformity
Despite an excellent operation, the post-operative period has been plagued by pain which has resulted in significant morbidity and increased length of stay
The five-point ERAS protocol spans the entirety of the patient's perioperative experience
The protocol includes perioperative education and counseling to establish reasonable expectations using educational materials and a boarding pass
The transitional pain service facilitates both pharmacologic and non-pharmacologic interventions to manage patient pain
Multimodal analgesia intraoperatively includes serratus anterior block and cryoablation at the time of procedure
A perioperative bowel regimen was included in the protocol
The boarding pass was a primary instrument to facilitate shared decision making and establish a therapeutic relationship between the team and patients
This is a single institution study at the Hospital for Sick Children with retrospective data for the pre-ERAS cohort and prospective data after implementation
53 patients were recruited from August 2015 to December 2021
All patients were approximately 15 years of age at the time of repair
Haller indices were typically above 4.5
92% of patients expressed satisfaction with their overall experience
There was a significant decrease in length of stay by 50%, from 4 days to just under 2 days
The mean length of stay was 1.8 days
The majority of patients were leaving on post-operative day one
There was a significant decrease in opioid consumption in the post-operative period from 6.36 to 3.12 morphine milliequivalents
Surgery remains a team sport
Successful surgical outcomes are predicated on a multi-disciplinary team working in each phase of care to optimize the patient's experience