Green Alyssa, Ramos-Gonzalez Gabriel, DeRosa JoAnn, Chandler Nicole M, Snyder Christopher W
Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
J Pediatr Surg. 2025 Mar;60(3):162060. doi: 10.1016/j.jpedsurg.2024.162060. Epub 2024 Nov 8.
Intercostal nerve cryoablation during minimally invasive repair of pectus excavatum (MIRPE) is an effective pain control technique. Some insurers may not reimburse for cryoablation in this context, contending that it's an experimental procedure. This study aimed to describe national trends in cryoablation use and evaluate outcomes and predictors of its use.
The Pediatric Health Information System database was queried for pectus excavatum patients aged 9-21 who underwent MIRPE between 2016 and 2023. Concurrent cryoablation use was identified using billing/supply codes. Temporal trends in cryoablation utilization were described and quantified using linear regression. Demographics, resource utilization, and outcomes were compared for patients based on cryoablation utilization using chi-square and Kruskal-Wallis tests. Predictors of cryoablation use were evaluated with logistic regression.
This analysis included 2068 patients (mean age 15 ± 1.8 years; 86 % male). Cryoablation utilization increased from 33 % to 61 % from 2016 to 2023, with a strong positive trend (R = 0.73). Cryoablation patients had fewer surgical complications (8 % vs 12 %, p = 0.004), shorter LOS (2.0 ± 1.3 vs. 2.8 ± 1.6 days, p < 0.001), fewer total mean opiate days billed (1.4 ± 1.1 vs. 1.6 ± 1.4 days, p < 0.0001) and higher total costs ($24,045 ± $9696 vs. $20,751 ± $9,237, p < 0.001). High-volume centers (odds ratio (OR) 1.9, 95 % confidence interval (CI) 1.2-3.0) and commercial HMO insurance (OR 2.7, 95 % CI 1.9-3.8) were predictors of cryoablation use.
Cryoablation during MIRPE has increased nationally since 2016; now being performed in nearly two-thirds of all cases. Cryoablation should be considered a standard adjunct to MIRPE rather than an experimental technique.
在微创漏斗胸修复术（MIRPE）期间进行肋间神经冷冻消融是一种有效的疼痛控制技术。一些保险公司可能不会为此种情况下的冷冻消融提供报销，称其为实验性手术。本研究旨在描述冷冻消融使用的全国趋势，并评估其使用的结果和预测因素。
查询儿科健康信息系统数据库，以获取2016年至2023年间接受MIRPE的9至21岁漏斗胸患者。使用计费/供应代码确定同时进行的冷冻消融使用情况。使用线性回归描述和量化冷冻消融利用的时间趋势。使用卡方检验和Kruskal-Wallis检验比较基于冷冻消融利用情况的患者的人口统计学、资源利用和结果。使用逻辑回归评估冷冻消融使用的预测因素。
该分析纳入了2068例患者（平均年龄15±1.8岁；86%为男性）。从2016年到2023年，冷冻消融的使用率从33%增加到61%，呈强烈的正趋势（R=0.73）。接受冷冻消融的患者手术并发症较少（8%对12%，p=0.004），住院时间较短（2.0±1.3天对2.8±1.6天，p<0.001），计费的总平均阿片类药物使用天数较少（1.4±1.1天对1.6±1.4天，p<0.0001），总成本较高（24,045±9696美元对20,751±9237美元，p<0.001）。高容量中心（优势比（OR）1.9，95%置信区间（CI）1.2-3.0）和商业健康维护组织保险（OR 2.7，95%CI 1.9-3.8）是冷冻消融使用的预测因素。
自2016年以来，MIRPE期间的冷冻消融在全国范围内有所增加；现在几乎在所有病例的三分之二都在进行。冷冻消融应被视为MIRPE的标准辅助手段，而非实验性技术。
