Journal of Pediatric Surgery Article REview: August Issue 2023

From the first quarter compared to the fourth quarter of the study, there was 74% less opioid use in Nuss procedures with cryoablation

80% of patients achieved early discharge home by postoperative day number 2 in the fourth quarter of the Nuss cryoablation study

The reduction in opioid use and length of stay was primarily related to discontinuing use of IV PCA during the study period

IV PCA does not seem to be necessary for Nuss procedures with cryoablation and can be eliminated fairly early in a surgeon's experience

The learning curve for cryoablation in Nuss procedures is not about technique but about pain protocols used around the time of surgery

Cryoablation implementation requires a protocol or regimen including pain team involvement preoperatively and postoperatively, with adjuncts such as gabapentin

Simple aspiration was successful in 33% of children with primary spontaneous pneumothorax

66% of children with primary spontaneous pneumothorax still required VATS after aspiration

Median length of stay with successful aspiration for pneumothorax was 20 hours (less than a day)

Median length of stay after VATS for pneumothorax was 3 days

For patients who went to VATS immediately after failed aspiration, median length of stay was 3.1 days, compared to 6 days for patients from the Midwest Pediatric Surgery Consortium

Updated APSA guidelines for solid organ injury management use the APSA framework: Admission, Procedures, Set free (discharge), and Aftercare

The most important change in the updated APSA guidelines is that discharge of a patient is not related to the severity of the injury but to the clinical condition of the patient

Activity restriction for solid organ injuries should be for two weeks at first, then adjusted based on level of injury

In the slipping rib syndrome study, 68 patients had rib resection without cryoablation (receiving other blocks), 22 had extrathoracic cryoablation, and 8 had slipping ribs resected as part of Nuss procedure

91% of cryoablation patients had cryoablation of T9 and T10 intercostal nerves with no documented abdominal wall laxity at 16-day follow-up

Patients who underwent rib excision with cryoablation used significantly less opioids in hospital compared to rib excision without cryoablation

Median length of stay was 1 day for patients with rib excision with cryoablation compared to 2 days for patients with rib excision without cryoablation

Patients with very low pectus deformities may have more discomfort in the lower costal margin area because it gets out of the field of T7 and T8 where most cryoablation is performed