Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience

Abstract

Background: We aimed to assess the effectiveness of the Nuss procedure for pectus excavatum (PE) and explore the impacts of sex and age on outcomes. Methods: We retrospectively reviewed 594 consecutive children ≤ 18 years of age who underwent the thoracoscopy-assisted Nuss technique between January 2006 and July 2019. The severity of pectus deformity was calculated according to the Haller index (HI). The classification of PE and clinical data including complications were analyzed. Results: Of the 594 patients, 456 (76.8%) were boys and 138 (23.2%) were girls. The mean age at surgery was 10.0±5.0 years. The most common types of PE were 1A and 2A2 according to Park’s classification. Intraoperative and postoperative complication rates were 2/594 (0.3%) and 74/594 (12.5%), respectively. The most common complication was bar displacement. The bar was removed in 414 patients 3.5±0.8 years later. The mean preoperative HI, postoperative HI with bar, and HI after bar removal were 4.2±1.7, 2.4±0.3 and 2.7±0.5, respectively. Compared to the preoperative HI, both the postoperative HI with bar and HI after bar removal were significantly lower (p<0.001). For preschool-age children, the preoperative HI was significantly higher (p=0.027) and the change in HI significantly improved compared to school-age children (p=0.004). Boys and adolescents needed significantly more bars and stabilizers. Conclusion: Surgical correction of PE using the Nuss procedure is a safe procedure and improves the HI in children of different ages, even in those younger than 6 years of age.