Mehl Steven C, Sun Raphael C, Anbarasu Centura R, Portuondo Jorge I, Espinoza Andres F, Whitlock Richard S, Shah Sohail R, Nuchtern Jed G, Minifee Paul K, Rodriguez J Ruben, Le Louis D, Stafford Shawn J, Mazziotti Mark V
Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas.
Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas.
Ann Thorac Surg. 2023 Oct;116(4):803-809. doi: 10.1016/j.athoracsur.2022.04.022. Epub 2022 Apr 27.
Intercostal nerve cryoablation with the Nuss procedure has been shown to decrease opioid requirements and hospital length of stay; however, few studies have evaluated the impact on complications and hospital costs.
A retrospective cohort study was performed for all Nuss procedures at our institution from 2016 through 2020. Outcomes were compared across 4 pain modalities: cryoablation with standardized pain regimen (n = 98), patient-controlled analgesia (PCA; n = 96), epidural (n = 36), and PCA with peripheral nerve block (PNB; n = 35). Outcomes collected included length of stay, opioid use, variable direct costs, and postoperative complications. Univariate and multivariate hierarchical regression analysis was used to compare outcomes between the pain modalities.
Cryoablation was associated with increased total hospital cost compared with PCA (cryoablation, $11 145; PCA, $8975; P < .01), but not when compared with epidural ($9678) or PCA with PNB ($10 303). The primary driver for increased costs was operating room supplies (PCA, $2741; epidural, $2767; PCA with PNB, $3157; and cryoablation, $5938; P < .01). With multivariate analysis, cryoablation was associated with decreased length of stay (-1.94; 95% CI, -2.30 to -1.57), opioid use during hospitalization (-3.54; 95% CI, -4.81 to -2.28), and urinary retention (0.13; 95% CI, 0.05-0.35).
Cryoablation significantly reduces opioid requirements and length of stay relative to alternative modalities, but it was associated with an increase in total hospital costs relative to PCA, but not epidural or PCA with PNB. Cryoablation was not associated with allodynia or slipped bars requiring reoperation.
已证明在努氏手术中进行肋间神经冷冻消融可减少阿片类药物用量并缩短住院时间；然而，很少有研究评估其对并发症和医院成本的影响。
对2016年至2020年在本机构进行的所有努氏手术进行回顾性队列研究。比较了4种疼痛治疗方式的结果：采用标准化疼痛治疗方案的冷冻消融（n = 98）、患者自控镇痛（PCA；n = 96）、硬膜外镇痛（n = 36）以及联合外周神经阻滞（PNB）的PCA（n = 35）。收集的结果包括住院时间、阿片类药物使用情况、可变直接成本和术后并发症。采用单因素和多因素分层回归分析比较不同疼痛治疗方式的结果。
与PCA相比，冷冻消融与总住院成本增加相关（冷冻消融，11145美元；PCA，8975美元；P < 0.01），但与硬膜外镇痛（9678美元）或联合PNB的PCA（10303美元）相比则不然。成本增加的主要驱动因素是手术室耗材（PCA，2741美元；硬膜外镇痛，2767美元；联合PNB的PCA，3157美元；冷冻消融，5938美元；P < 0.01）。多因素分析显示，冷冻消融与住院时间缩短（-1.94；95%CI，-2.30至-1.57）、住院期间阿片类药物使用减少（-3.54；95%CI，-4.81至-2.28）以及尿潴留减少（0.13；95%CI，0.05 - 0.35）相关。
相对于其他治疗方式，冷冻消融显著降低了阿片类药物需求和住院时间，但与PCA相比，其与总住院成本增加相关，而与硬膜外镇痛或联合PNB的PCA相比则不然。冷冻消融与异常性疼痛或需再次手术的钢板移位无关。
