Postoperative benefits of cryoanalgesia in minimally invasive repair of pectus excavatum: Results from a tertiary referral center.

INTRODUCTION

Minimally invasive repair of pectus excavatum (MIRPE) is associated with significant postoperative pain, and opioid use remains common despite Enhanced Recovery After Surgery (ERAS) protocols. Cryoanalgesia has emerged as a promising adjunct to improve pain control, but its comparative effectiveness within established ERAS pathways remains incompletely defined. We aimed to evaluate opioid use and recovery outcomes following cryoneurolysis compared to a thoracic epidural-based ERAS protocol.

METHODS

We performed a retrospective cohort study of pediatric and young adult patients undergoing MIRPE from 2017 to 2024. Outcomes included inpatient opioid use and outpatient opioid prescribing (MME/kg), length of stay (LOS), and postoperative care utilization. Groups were compared using appropriate univariate tests, and multivariable models adjusted for age, Haller index, and calendar year of surgery.

RESULTS

Among 245 patients (median age 16.0 years), 124 (50.6%) received cryoanalgesia. Baseline characteristics were similar between groups. Cryoanalgesia was associated with significantly reduced opioid use and prescribing (inpatient: 6.10 vs. 18.55 MME/kg; outpatient: 1.70 vs. 7.91 MME/kg; both P < 0.0001) and shorter LOS (2.01 vs. 3.25 days, P < 0.0001), with these associations remaining significant after adjustment for age, Haller index, and calendar year of surgery. Routine outpatient care needs and surgical complication rates were similar between groups. Cryoanalgesia was associated with a modest increase in unplanned postoperative visits, without a difference in the proportion of patients affected (28.1% without cryoanalgesia vs 22.6% with cryoanalgesia, P = 0.322).

CONCLUSION

Cryoneurolysis was associated with substantial reductions in opioid use and shorter hospitalization without increased routine follow-up. A modest increase in unplanned visits warrants further study. These findings support cryoanalgesia as an effective adjunct to multimodal pain management in MIRPE.

IRB APPROVAL STATEMENT: This protocol was approved by the Institutional Review Board at Mass General Brigham, and a waiver of informed consent for medical records review was obtained (Protocol #: 2025P001162).