Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States; Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
J Pediatr Surg. 2021 Dec;56(12):2229-2234. doi: 10.1016/j.jpedsurg.2021.03.006. Epub 2021 Mar 17.
Recent studies have shown intercostal cryoablation(IC) during the Nuss procedure decreases hospital length of stay(LOS) and opioid administration. However, few studies have also evaluated the risk of postoperative complications related to IC.
We performed a single center retrospective analysis of all patients who underwent Nuss procedure by one surgeon from 2/2016 to 2/2020, comparing intraoperative IC to other pain management modalities(non-IC). Primary outcomes were postoperative complications, hospital LOS, and opioid administration. Multivariate analysis was performed with outcomes reported as regression coefficients(RC) or odds ratios(OR) with 95% confidence interval.
IC was associated with decreased hospital LOS (RC -1.91[-2.29 to -1.54], less hospital opioid administration (RC -4.28[-5.13 to -3.43]), and less discharge opioid administration (RC -3.82[-5.23 to -2.41]). With respect to postoperative complications, IC decreased the odds of urinary retention (OR 0.16[0.06 to 0.44]); however, increased the odds of slipped bars requiring reoperation (OR 36.65[5.04-266.39]).
Our single surgeon experience controls for surgeon variability and demonstrates intraoperative IC for the Nuss procedure is an effective pain management modality that decreases hospital LOS and opioid use during hospitalization and at discharge; however, it is associated with increased odds of slipped bars requiring reoperation.
III.
最近的研究表明，在 Nuss 手术中进行肋间冷冻消融（IC）可以降低住院时间（LOS）和阿片类药物的使用。然而，也有少数研究评估了与 IC 相关的术后并发症风险。
我们对 2016 年 2 月至 2020 年 2 月期间由一位外科医生进行的所有 Nuss 手术患者进行了单中心回顾性分析，比较了术中 IC 与其他疼痛管理方式（非 IC）。主要结局是术后并发症、住院 LOS 和阿片类药物的使用。采用回归系数（RC）或比值比（OR）及其 95%置信区间报告多变量分析结果。
IC 与住院 LOS 缩短相关（RC -1.91[-2.29 至 -1.54]）、住院阿片类药物使用减少（RC -4.28[-5.13 至 -3.43]）和出院阿片类药物使用减少（RC -3.82[-5.23 至 -2.41]）。就术后并发症而言，IC 降低了尿潴留的几率（OR 0.16[0.06 至 0.44]）；然而，增加了需要再次手术的滑杆的几率（OR 36.65[5.04-266.39]）。
我们的单外科医生经验控制了外科医生的变异性，并表明 Nuss 手术中的术中 IC 是一种有效的疼痛管理方式，可降低住院 LOS 和住院期间及出院时的阿片类药物使用量；然而，它与需要再次手术的滑杆的几率增加有关。
III 级。
