Cryoanalgesia enhances recovery from minimally invasive repair of pectus excavatum resulting in re duce d length of stay: A case-matched analysis of NSQIP-Pediatric patients

Purpose: Pain control is challenging after minimally invasive repair of pectus excavatum (MIRPE). Cryoanalgesia, which temporarily ablates peripheral nerves, improves pain control and may accelerate post-operative recovery. We hypothesized that cryoanalgesia would be associated with shorter length of stay (LOS) in children undergoing MIRPE. Methods: A matched cohort study was conducted of children ( < 18 years) who underwent MIRPE 2016- 2018, using the National Surgical Quality Improvement Program-Pediatric database. Each patient who received cryoanalgesia during MIRPE was matched to four controls (no cryoanalgesia). Univariate and multilevel regression analyses were performed. Results: Thirty-five patients who received cryoanalgesia during MIRPE were matched to 140 controls. Patients who received cryoanalgesia had a LOS reduction with similar secondary outcomes (operative time, rates of complication, reoperation, and readmission). On multilevel regression adjusted for matched groups, cryoanalgesia was associated with a 1.3-day reduction in LOS (95% CI -1.8 to -0.8, p < 0.001). On sensitivity analysis excluding patients with complications, cryoanalgesia remained associated with a LOS reduction. Conclusions: Cryoanalgesia is a promising adjunct in the care of pediatric patients undergoing MIRPE. Utilization is associated with a shorter LOS without an increase in operative time or complications. Cryoanalgesia should be considered for inclusion in enhanced recovery strategies for patients undergoing MIRPE. (c) 2021 Elsevier Inc. All rights reserved.

Automated summary

In children undergoing minimally invasive repair of pectus excavatum, cryoanalgesia is associated with a reduction in length of stay without an increase in operative time or complication rates. This suggests that cryoanalgesia may be a promising adjunct for enhancing recovery strategies in pediatric patients undergoing MIRPE.