Short and Long Term Outcomes of Using Cryoablation for Post-operative Pain Control in Patients After Pectus Excavatum Repair

Background: Previous prospective trials have demonstrated that intercostal cryoablation reduces length of stay and postoperative opioid consumption compared with thoracic epidural and patient controlled analgesia (PCA) modalities. We report the findings of a 3-year prospective, observational study to elucidate long-term pain control, symptoms, and complications with attention to postoperative short and long-term pain control associated with the cryoablation technique.

Methods: Following IRB approval, we prospectively collected data on patients who underwent bar placement for pectus excavatum with thoracoscopic intercostal cryoablation by six surgeons at our institution from 2017 to 2021. Patients and their parents completed surveys regarding pain scores, narcotic and non-narcotic pain medication usage, and limitations to activity beginning on the day of surgery for up to 10 days, with a supplementary survey on the day of discharge to evaluate pain and associated symptoms. Surveys were administered at two-week and three-month follow-up appointments addressing pain control, symptoms, and limitations to activity. Retrospective review of chart data was performed to identify the number of emergency department visits, phone calls to the outpatient surgery office, and requirement for additional pain medication.

Results: 110 patients were included in the analysis; 90% were male with a median age of 15.8 years [14.6, 16.7]. The median length of stay was 25.6 hours [22.3, 31.7]. Forty-eight patients (44%) completed the discharge survey; sharp pain and pressure on the first night of surgery were the most described pain characteristics, with sharp pain being the worst symptom reported most frequently in the middle of the chest. (Table 1) On postoperative follow-up, 55% of patients reported tolerable residual pain at two weeks and 41% at three months, with a median pain score of 3 at each follow-up interval and 25% of survey respondents requiring intermittent non-narcotic pain medication at three months. There were 18 (16%) ED visits by two-week follow-up, resulting in 3 readmissions for inadequate pain control: two on postoperative day two and one on postoperative day five. By three-month follow-up, there were 65 calls to the surgery clinic, most commonly for persistent pain and frequent popping sensation with movement, and no additional patients required readmission for pain control within this longer interval. (Table 2)

Conclusion: Although cryoablation is an excellent pain control modality to attenuate the acute insult of bar placement, these data suggest that patients underreport functional symptoms and experience more frequent discomfort and alteration of activities of daily living than perceived by providers. Prospective validation is necessary to examine the nature of specific symptoms, duration, and impact on the patient’s quality of life.