微创漏斗胸矫正术中使用冷冻镇痛对儿科患者住院天数和总住院费用的影响。

Impact of Cryoanalgesia Use During Minimally Invasive Pectus Excavatum Repair on Hospital Days and Total Hospital Costs Among Pediatric Patients.

机构信息

Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, USA.

Department of Pediatrics, McGovern Medical School at University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 3.020, Houston, TX 77030, USA; Center for Clinical Research and Evidence Based Medicine, McGovern Medical School at University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.106, Houston, TX 77030, USA.

出版信息

J Pediatr Surg. 2023 Jul;58(7):1235-1238. doi: 10.1016/j.jpedsurg.2023.02.036. Epub 2023 Feb 17.

DOI:10.1016/j.jpedsurg.2023.02.036

PMID:36922280

Abstract

INTRODUCTION

Surgical repair of pectus excavatum is a painful procedure requiring multimodal pain control with historically prolonged hospital stay. This study aimed to evaluate the impact of cryoanalgesia during minimally invasive repair of pectus excavatum (MIRPE) on hospital days (HDs), total hospital costs (HCs), and complications. We hypothesized that cryoanalgesia would be associated with reduced HDs and total HCs with no increase in post-operative complications.

METHODS

We conducted a retrospective review of pediatric patients who underwent MIRPE from 2011 to 2021. MIRPE details and post-operative outcomes within 90 days were abstracted. Total HDs included the index MIRPE admission and readmissions within 90 days. HCs were obtained from the hospital accounting system, retroactively adjusting for medical inflation. Bayesian generalized linear models with neutral prior assuming no effect were used. Differences between treatment groups were assessed using gamma distribution (HDs and HCs) and poisson (post-operative complications). All models used log link and controlled for age, gender, race, and Haller index.

RESULTS

Forty-four patients underwent MIRPE during the study period. Cryoanalgesia was utilized in 29 (66%) patients. The probability of a reduction with cryoanalgesia vs. no cryoanalgesia was 99% for HDs (3.0 vs. 5.4 days; Bayesian RR: 0.6, 95% CrI: 0.5-0.8), 89% for HCs ($18,787 vs. $19,667; RR: 0.9, 95% CrI: 0.8-1.1), and 70% for postoperative complications (17% vs 33%; RR: 0.8, 95% CrI: 0.3-1.9).

CONCLUSION

Cryoanalgesia use in MIRPE likely reduced HDs, HCs, and post-operative complications. Further research is warranted to confirm these findings in large prospective studies.

LEVEL OF EVIDENCE

Level III.

摘要

简介

胸壁凹陷畸形的手术修复是一个痛苦的过程，需要多模式疼痛控制，历史上需要长时间住院。本研究旨在评估微创修复胸壁凹陷畸形（MIRPE）过程中冷冻镇痛对住院天数（HDs）、总住院费用（HCs）和并发症的影响。我们假设冷冻镇痛会减少 HDs 和总 HCs，而不会增加术后并发症。

方法

我们对 2011 年至 2021 年间接受 MIRPE 的儿科患者进行了回顾性研究。提取 MIRPE 细节和术后 90 天内的结果。总 HDs 包括指数 MIRPE 入院和 90 天内的再入院。HCs 从医院会计系统中获得，回溯调整医疗通胀。使用假设无影响的中性先验的贝叶斯广义线性模型。使用伽马分布（HDs 和 HCs）和泊松（术后并发症）评估治疗组之间的差异。所有模型均使用对数链接，并控制年龄、性别、种族和 Haller 指数。

结果

在研究期间，44 名患者接受了 MIRPE。29 名（66%）患者使用了冷冻镇痛。与无冷冻镇痛相比，冷冻镇痛降低 HDs 的概率为 99%（3.0 天 vs. 5.4 天；贝叶斯 RR：0.6，95%CrI：0.5-0.8），降低 HCs 的概率为 89%（18787 美元 vs. 19667 美元；RR：0.9，95%CrI：0.8-1.1），降低术后并发症的概率为 70%（17% vs. 33%；RR：0.8，95%CrI：0.3-1.9）。