Intercostal Nerve Cryoablation in Minimally Invasive Repair of Pectus Excavatum: National Trends, Outcomes, and Predictors of Utilization

Abstract

Purpose: 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.

Methods: 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.

Results: 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 (R² = 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.

Conclusion: 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.

Keywords: Cryoanalgesia; Intercostal nerve cryoablation; Minimally invasive repair of pectus excavatum; Nuss procedure; Pectus excavatum; Pediatric health information system; Pediatric surgery pain management.