Multicenter, real-world patient registry outcomes from intercostal nerve cryoablation during robotic-assisted thoracic surgical procedures.

Background: Robotic-assisted thoracic surgery (RATS) is gaining wider adoption as a minimally invasive technique, although best practices for pain management are unclear. Intercostal nerve cryoablation (cryoNB) has emerged as a promising adjunct for postoperative pain control in thoracic surgery, but evidence supporting its use in RATS is limited. The aim of this study was to evaluate real-world outcomes after cryoNB in RATS. Methods: Cryoanalgesia Registry for Pain Management in Post-cardiothoracic Surgery via Cryoablation of the Intercostal Nerves (REDUCE) (NCT05110989) is a retrospective and prospective, multicenter, observational registry. Patient demographics, procedural characteristics, and the incidence of procedure- and device-related adverse events through follow-up were analyzed. Opioid use during the postoperative hospital stay and the proportion of patients discharged with an opioid prescription were quantified. Pain scores using numerical rating scale and incentive spirometry effort were evaluated postoperatively and through follow-up. Results: Data from 428 patients enrolled in the REDUCE registry across five U.S. centers were included between 2018-2025. Median age was 68 years [interquartile range (IQR), 61-74 years] and 54.7% (234/428) were female. Pre-procedure, 19% of patients had a history of chronic pain. The most common surgical procedures performed were lobectomy (34.1%; 218/638) and wedge resection (26.2%; 167/638). The median length of stay was 3 days (IQR, 3-4 days). There were no serious adverse events related to the cryoNB procedure or devices. Median pain scores on postoperative day (POD) 1 were 3.8 (IQR, 0.5-6), 2.0 (IQR, 0-4) on POD 4, 2.0 (IQR, 0-4) after discharge and through 30 days, and 1.0 (IQR, 0-2) between 31-60 days. Pulmonary function measured by median incentive spirometry effort on POD 1 was 1250 mL (IQR, 750-1,500 mL) and 1,375 mL (IQR, 1,000-1,500 mL) on POD 4. Incentive spirometry levels remained above 2,000 mL during the follow-up period. Median postoperative opioid use decreased during the hospital stay from 22.5 morphine milligram equivalents (MME) (IQR, 9-34.4 MME) on POD 1 to 0 MME (IQR, 0-8.6 MME) on POD 4. Nearly half (47.1%; 139/295) of patients with logged medications did not require an opioid prescription at discharge. Conclusions: This study describes real-world safety and perioperative outcomes in patients undergoing RATS with adjunctive cryoNB using the REDUCE registry. In this observational cohort, patients who received cryoNB demonstrated decreasing opioid use over the course of hospitalization, with adequate pain control and preserved incentive spirometry volumes throughout the postoperative and follow-up period.