Association of Regional Anesthetic Approach and Center-Level Surgical Volume with Outcomes after Surgical Repair of Pectus Excavatum

Abstract

INTRODUCTION: Variability in regional anesthetic approach and surgical volume may affect outcomes in patients undergoing surgical management of pectus excavatum. This study investigated how regional anesthetic approach and center-level surgical volume impacts length of stay (LOS), postoperative narcotic use, and operating room (OR) utilization. METHODS: After IRB approval, we conducted a 10-center retrospective chart review of patients younger than 18 who underwent repair of pectus excavatum between 2015 and 2021. High-volume centers (HVC; 6/10 centers) were defined as performing 100 cases or more over the study period. Surgical time was incision to closure and incorporated within OR time. RESULTS: Of 920 patients meeting inclusion criteria, 757 (82%) underwent surgical repair at HVC; 20% received no regional anesthesia, 24% epidural, 15% erector spinae catheter, 19% cryo-analgesia, 10% cryo-analgesia with local rib block (LRB), and 12% other combinations including serratus anterior, paravertebral, and intrathecal morphine. Univariable associations between regional anesthesia type and center volume on outcomes are shown in Table 1. On multivariable analysis, independent predictors of shorter LOS were cryo-analgesia ± LRB and HVC. Epidural and LRB alone were independently associated with increased LOS. HVC, cryo-analgesia ± LRB, and LRB alone were independently predictive of less MME after surgery. Epidural, LRB, and cryo-analgesia with LRB were predictive of increased surgical and OR time; erector spinae catheters were predictive of longer OR time only. Table 1. - Impact of Regional Anesthesia and Surgical Volume on Outcomes Regional anesthesia and surgical volume Length of stay (d) Milligram morphine equivalents (MME) Surgical time (min) OR time (min) Regional type (n) No regional (185) 4 (3–5) 202 (120–338) 89 (72–131) 155 (130–198) Epidural catheter (223) 4 (3–5) 120 (66–218) 106 (77–167) 196 (161–251) Erector spinae catheter (139) 2 (2–2) 68 (51–124) 90 (75–109) 191 (172–216) Local rib block (64) 4 (3–5) 60 (4–100) 104 (76–136) 184 (152–227) Cryo-analgesia (179) 1 (1–1) 61 (23–125) 101 (80–130) 149 (120–186) Cryo-analgesia with local rib block (92) 2 (1–2) 30 (15–83) 141 (125–162) 205 (182–227) Center volume (n): High-volume (757) 3 (2–4) 83 (38–195) 100 (77–132) 180 (150–208) Low-volume (163) 4 (3–4) 122 (68–225) 137 (87–168) 209 (148–261) CONCLUSION: Anesthetic approach and center-level surgical volume are associated with length of stay, postoperative narcotic use, and OR utilization after repair of pectus excavatum.