دورية أكاديمية
Six Years of Quality Improvement in Pectus Excavatum Repair: Implementation of Intercostal Nerve Cryoablation and ERAS Protocols for Patients Undergoing Nuss Procedure.
| العنوان: | Six Years of Quality Improvement in Pectus Excavatum Repair: Implementation of Intercostal Nerve Cryoablation and ERAS Protocols for Patients Undergoing Nuss Procedure. |
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| المؤلفون: | Rook JM; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Greater Los Angeles Veterans Administration Healthcare System, Los Angeles, CA, USA; UCLA National Clinician Scholars Program, Los Angeles, CA, USA; Department of Health Policy & Management, UCLA Fielding School of Public Health, USA. Electronic address: jrook@mednet.ucla.edu., Lee LK; Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Wagner JP; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Sullins VF; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Lee SL; Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA., Shekherdimian S; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., DeUgarte DA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Dichter CE; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Jen HC; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. |
| المصدر: | Journal of pediatric surgery [J Pediatr Surg] 2024 Jul 20. Date of Electronic Publication: 2024 Jul 20. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Saunders Country of Publication: United States NLM ID: 0052631 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-5037 (Electronic) Linking ISSN: 00223468 NLM ISO Abbreviation: J Pediatr Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Philadelphia, PA : Saunders Original Publication: New York. |
| مستخلص: | Background: The Nuss procedure for pectus excavatum is associated with prolonged hospitalizations due to pain. We evaluated implementation of intercostal nerve cryoablation and enhanced recovery after surgery (ERAS) protocols on outcomes of Nuss procedures performed over six years at a single institution. Methods: This retrospective cohort study included patients who underwent Nuss procedure from 10/2017 to 09/2023. Patients received epidurals prior to 06/2019, cryoablation from 06/2019 to 07/2021, and ERAS with cryoablation and intraoperative methadone administration after 07/2021. We used multivariable linear regression to evaluate length of stay (LOS), inpatient morphine milligram equivalents (MMEs), and discharge opioids. We assessed the balancing measures of operative time, postoperative pain scores, and complications. Results: We identified 62 patients; 15 who received epidurals, 18 cryoablation, and 29 cryoablation with ERAS. Cryoablation was associated with a 62.3% (p < 0.001) decrease in length of stay, an 86.6% (p < 0.001) decrease in inpatient MMEs, and a 72.9% (p < 0.001) decrease in discharge opioids. Cryoablation was additionally associated with 24.5% (p = 0.02) longer operative times and 46.4% (p = 0.04) higher postoperative day one pain scores. Subsequent implementation of an ERAS protocol was associated with a further 82.8% (p = 0.04) decrease in discharge opioids and a 25.0% (p = 0.04) decrease in postoperative day one pain scores. Conclusions: Over six years of quality improvement efforts, we found the implementation of cryoablation and ERAS protocols to be associated with a significant decrease in length of stay and opioid exposures. Protocolized pain management and cryoablation may work synergistically to improve outcomes without compromising patient experience. Level of Evidence: Level III - Retrospective comparative study. Competing Interests: Conflicts of interest The authors have no conflicts of interest to disclose. The authors did not receive any financial support nor incentives to conduct this research. (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Cryoablation; ERAS; Methadone; Nuss procedure; Pectus excavatum |
| تواريخ الأحداث: | Date Created: 20240808 Latest Revision: 20240808 |
| رمز التحديث: | 20240809 |
| DOI: | 10.1016/j.jpedsurg.2024.07.019 |
| PMID: | 39117536 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1531-5037 |
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| DOI: | 10.1016/j.jpedsurg.2024.07.019 |