Impact of cryoablation on operative outcomes in thoracotomy patients

Abstract

OBJECTIVES Cryoablation is increasingly being utilized as an alternative to epidurals for patients undergoing thoracotomies. Current evidence suggests cryoablation may decrease post-operative analgesia utilization, but could increase operative times. We hypothesized that the adoption of intraoperative cryoablation to manage post-thoracotomy pain would result in reduced length of stay and reduced perioperative analgesia compared to routine epidural use. METHODS A retrospective analysis was performed from a single, quaternary referral center, prospective database on patients receiving thoracotomies between 01/2020—03/2022. Patients undergoing transthoracic hiatal hernia repair, lung resection, or double lung transplant were divided between epidural and cryoablation cohorts. Primary outcomes were length of stay, intraoperative procedure time, crossover pain management, and oral narcotic usage the day before discharge. RESULTS During the study period, 186 patients underwent a transthoracic hiatal hernia repair, lung resection, or double lung transplant with 94 receiving a pre-operative epidural and 92 undergoing cryoablation. Subgroup analysis demonstrated no significant differences in demographics, operative length, length of stay, or peri-operative narcotic use. Notably, over a third of patients in each cryoablation subgroup received a post-operative epidural (45.5% transthoracic hiatal hernia repair, 38.5% lung resection, and 45.0% double lung transplant) for further pain management during their admission. CONCLUSIONS Cryoablation use was not associated with an increase in procedure time, a decrease in narcotic use, or length of stay. Surprisingly, many cryoablation patients received epidurals in the postoperative period for further pain control. Additional analysis is needed to fully understand the benefits and costs of epidural versus cryoablation strategies.