Impact of Delayed Removal of Pectus Bar on Outcomes Following Nuss Repair: A Retrospective Analysis

Abstract

Abstract Background Usually, pectus bars are removed 3 years after Nuss procedure in patients with pectus excavatum. However, the optimal timing for postoperative pectus bar removal remains undefined. Our study investigated the effects of delayed pectus bar removal after Nuss repairs. Methods Retrospective data were collected on patients who underwent Nuss procedures for pectus excavatum and had their bars removed from August 2014 to December 2020. Patients with correction period > 3 years were divided into group A (< 6 years) and group B (≥ 6 years). Propensity score matching was used to compare complications and radiological outcomes associated with bar removal. Results Of the 542 patients who underwent bar removal, 451 (Group A: 419 patients, Group B: 32) had correction duration > 3 years. The average correction duration was 4.5 ± 1.4 years. After propensity score matching analysis, group B (mean: 8.0 (6.0–16.2) years) exhibited significantly longer median operative times (85 vs 55 min; P = 0.026), higher callus formation rates (68.8% vs 46.9%; P = 0.029), and greater median intraoperative blood loss (35 vs 10 mL; P = 0.017) than group A (mean: 4.2 (3.0–5.9) years). However, following bar removal, the groups showed no statistical differences in the surgical complication rates (group A: 6.3% vs group B: 9.4%; P = 0.648) or median ratio of radiological improvement (an improvement on the Haller index on chest radiograph, 21.0% vs 22.2%; P = 0.308). Conclusions Delaying pectus bar removal after Nuss repair presents certain challenges but does not compromise overall outcomes. These findings suggest that a longer correction period may be unnecessary. However, further multicenter studies with long-term follow-up are warranted to assess long-term outcomes.