National trends in pectus excavatum repair: patient age, facility volume, and outcomes

Abstract

Background: There is limited data on the adult repair of pectus excavatum (PE). Existing literature is largely limited to single institution experiences and suggests that adults undergoing modified Nuss repair may have worse outcomes than pediatric and adolescent patients. Using a representative national database, this analysis is the first to describe trends in demographics, outcomes, charges, and facility volume for adults undergoing modified Nuss procedure.Methods: Because of a coding change associated with ICD-10, a retrospective cohort analysis using the National Inpatient Sample (NIS) for patients 12 or older undergoing modified Nuss repair between 2016-2018 was possible. Pearson's χ 2 and Student's t-tests were utilized to compare patient, clinical, and hospital characteristics. Complications were sub-classified into major and minor categories. Facilities performing greater than the mean number of operations were categorized as high-volume.Results: Of 360 patients, 79.2% were male. There was near gender parity for patients over 30 undergoing repair (55.2% male, 44.8% female). In all age cohorts, patients were predominantly Caucasian. Rates of any postoperative complication differed by age (12-17 years: 30.6%; 18-29 years: 45.2%; 30+ years: 62.1%; P<0.01); older patients had higher rates of all but two subclasses of complication.

Evaluating Skeletal Maturity at Time of Surgical Correction of Pectus Excavatum Based on Medial Clavicle Epiphyseal Ossification

“…10 Furthermore, increased age is associated with an increased risk for complications. [4][5][6][7][8][9] Surgeons today are attempting to balance ease of repair, risk of complication, and possibility of recurrence with desire to have the bar in place near the conclusion of skeletal maturation. Our findings demonstrate that a more immature Schmeling-Kellinghaus stage consumes less inpatient and total ME/Kg than the more mature complements.…”

“…3 This is affecting an overall trend toward increasing age of correction despite evidence for less postoperative pain, decreased complication rates, shorter inpatient stay, and better cosmetic results when correction is performed at younger ages. [4][5][6][7][8][9][10][11][12][13] Nevertheless, what has been largely unexploited in the preoperative evaluation of adolescents and young adults with pectus excavatum (PE) is the underlying mechanism which drives variability in chest wall pliability-the chest wall's complex developmental process which begins the sixth week of gestation and concludes as late as the 3 rd decade of life. 14,15 As skeletal maturation occurs at different rates, a patient-specific approach to timing of correction is warranted.…”