In-hospital outcomes of intercostal nerve cryoablation and surgical stabilization of rib fractures

BACKGROUND Severe pain and pulmonary complications commonly follow rib fractures, both of which may be improved by surgical stabilization of rib fractures (SSRFs). However, significant postoperative pain still persists which may negatively impact in-hospital outcomes. Combining intercostal nerve cryoablation (INCA) with SSRF may improve those outcomes by further decreasing postoperative pain, opioid consumption, and pulmonary complications. The hypothesis is that INCA plus SSRF reduces opioids consumption compared with SSRF alone. METHODS The retrospective analysis included trauma patients 18 years or older who underwent SSRF, with or without INCA, in a Level I trauma center between 2015 and 2021. Patients received INCA at the surgeons' discretion based on familiarity with the procedure and absence of contraindications. Patients without INCA were the historical control group. Reported data include demographics, mechanism and severity of injury, number of ribs stabilized, cryoablated nerves, intubation rates and duration of mechanical ventilation. The primary outcome was total morphine milligrams equivalent consumption. Secondary outcomes were intensive care unit length of stay, hospital length of stay, incidence of pneumonia, and tracheostomy rates, and discharge disposition. Long-Term outcomes were examined up to 6 months for adverse events. RESULTS Sixty-eight patients were included, with 44 receiving INCA. There were no differences in rates of pneumonia (p = 0.106) or duration of mechanical ventilation (p = 0.687), and hospital length of stay was similar between groups (p = 0.059). However, the INCA group demonstrated lower total morphine milligrams equivalent (p = 0.002), shorter intensive care unit length of stay (p = 0.021), higher likelihood of home discharge (p = 0.044), and lower rate of intubation (p = 0.002) and tracheostomy (p = 0.032). CONCLUSION Combining INCA with SSRF may further improve in-hospital outcomes for patients with traumatic rib fractures. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.