Long-Term Recurrence Rates and Patient Satisfaction after Repair of Pectus Excavatum

Abstract

Background Pectus excavatum deformities are usually repaired with a minimally invasive approach in which a metal bar is used to correct the chest wall abnormality. We aimed to evaluate long-term outcomes and patient satisfaction after surgical correction.

Methods Patients who underwent pectus excavatum repair and subsequent bar removal at a single tertiary care center from January 2000 to December 2020 were identified. A retrospective chart review was performed, and a telephone survey was conducted to evaluate perceived inward chest movement, need for surgeon reevaluation, surgical reintervention, and overall satisfaction. Data are presented as medians with interquartile ranges (IQRs) and frequencies with percentages.

Results A total of 583 patients were included. The survey response rate was 26.2% (n = 153). The respondents were predominantly male (80.4%, n = 123) with a median age at surgical correction of 14.9 years (IQR 12.9, 16.1) and a median Haller index (HI) of 3.8 (IQR 3.4, 4.5). Median time to bar removal was 2.9 years (IQR 2.5, 3.0) with a median age at removal of 17.7 years (IQR 15.5, 19.0). Median time from surgery to survey follow-up was 9.6 years (IRQ 5.0, 11.4) with respondents having a median age at follow-up of 25 years (IQR 22.0, 28.4). The satisfaction rate was 96.7% (n = 148) with a reintervention rate of 2.0% (n = 3). The perceived inward chest movement was 30.7% (n = 47) with 12.8% (n = 6) of those requesting surgical reevaluation.

Conclusion There is a high level of satisfaction many years after correction of pectus excavatum and bar removal. With the advent of cryoablative therapy since 2017, patient satisfaction improved by experience of less postoperative pain. Reintervention rate is low despite some patients reporting a perceived chest wall inward movement.

Keywords

pectus excavatum - outcomes - satisfaction - recurrence - chest wall

Publication History

Received: 17 April 2023

Accepted: 22 June 2023

Accepted Manuscript online:
14 July 2023

Article published online:
09 August 2023

• References

• 1 Antonoff MB, Saltzman DA, Hess DJ, Acton RD. Retrospective review of reoperative pectus excavatum repairs. J Pediatr Surg 2010; 45 (01) 200-205
• 2 Shamberger RC. Congenital chest wall deformities. Curr Probl Surg 1996; 33 (06) 469-542
• 3 de Carvalho RLC, Tedde ML, de Campos JRM. et al. Quality of life outcomes after minimally invasive repair of pectus excavatum utilizing a new set of metallic bars and stabilizers. J Pediatr Surg 2021; 56 (03) 545-549
• 4 Nuss D, Kelly Jr RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998; 33 (04) 545-552
• 5 Haller Jr JA, Colombani PM, Humphries CT, Azizkhan RG, Loughlin GM. Chest wall constriction after too extensive and too early operations for pectus excavatum. Ann Thorac Surg 1996; 61 (06) 1618-1624 , discussion 1625
• 6 Dekonenko C, Dorman RM, Duran Y. et al. Postoperative pain control modalities for pectus excavatum repair: a prospective observational study of cryoablation compared to results of a randomized trial of epidural vs patient-controlled analgesia. J Pediatr Surg 2020; 55 (08) 1444-1447
• 7 Hanna WC, Ko MA, Blitz M, Shargall Y, Compeau CG. Thoracoscopic Nuss procedure for young adults with pectus excavatum: excellent midterm results and patient satisfaction. Ann Thorac Surg 2013; 96 (03) 1033-1036 , discussion 1037–1038
• 8 Sacco Casamassima MG, Gause C, Goldstein SD. et al. Patient satisfaction after minimally invasive repair of pectus excavatum in adults: long-term results of Nuss procedure in adults. Ann Thorac Surg 2016; 101 (04) 1338-1345
• 9 Matsuura R, Tazuke Y, Ueno T. et al. Factors reducing psychological satisfaction after the Nuss procedure in pediatric patients. Asian J Endosc Surg 2023; 16 (01) 28-34
• 10 Barua A, Rao VP, Barua B, Majewski A. Patient satisfaction following minimally invasive repair of pectus excavatum: single surgeon experience. J Surg Tech Case Rep 2012; 4 (02) 86-88
• 11 Gould JL, Sharp RJ, Peter SD. et al. The minimally invasive repair of pectus excavatum using a subxiphoid incision. Eur J Pediatr Surg 2017; 27 (01) 2-6
• 12 Jukić M, Mustapić I, Šušnjar T, Pogorelić Z. Minimally invasive modified Nuss procedure for repair of pectus excavatum in pediatric patients: single-centre retrospective observational study. Children (Basel) 2021; 8 (11) 1071
• 13 Zuidema WP, van der Steeg AFW, van der Heide S. et al. The outcome of the single step questionnaire in pectus excavatum patients is phase dependent. Eur J Pediatr Surg 2020; 30 (02) 205-209
• 14 Burkhart Q, Orr N, Brown JA. et al. Associations of mail survey length and layout with response rates. Med Care Res Rev 2021; 78 (04) 441-448
• 15 Sinkowitz-Cochran RL. Survey design: to ask or not to ask? That is the question. Clin Infect Dis 2013; 56 (08) 1159-1164
• 16 Tikka T, Kalkat MS, Bishay E, Steyn RS, Rajesh PB, Naidu B. A 20-year review of pectus surgery: an analysis of factors predictive of recurrence and outcomes. Interact Cardiovasc Thorac Surg 2016; 23 (06) 908-913
• 17 Kelly RE, Goretsky MJ, Obermeyer R. et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg 2010; 252 (06) 1072-1081
• 18 Gibreel W, Zendejas B, Joyce D, Moir CR, Zarroug AE. Minimally invasive repairs of pectus excavatum: surgical outcomes, quality of life, and predictors of reoperation. J Am Coll Surg 2016; 222 (03) 245-252
• 19 Sujka J, Benedict LA, Fraser JD, Aguayo P, Millspaugh DL, St Peter SD. Outcomes using cryoablation for postoperative pain control in children following minimally invasive pectus excavatum repair. J Laparoendosc Adv Surg Tech A 2018; 28 (11) 1383-1386