Multivariate analysis of risk factors for Nuss bar infections: A single center study

Obermeyer, Robert J.; Cohen, Nina; Gaffar, Sheema; Kelly, Robert E.; Kuhn, M. Ann; Frantz, Frazier W.; McGuire, Margaret; Paulson, James F.

doi:10.1016/j.jpedsurg.2018.02.090

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…Postoperative complications of the Nuss procedure have been reported in several studies [4][5][6][7][8][9]12,25]; common complications included postoperative pneumothorax, pleural effusion, bar displacement requiring reoperation (1.7%-6.6%), pericardial effusion, hemothorax requiring blood transfusion or reoperation, cardiac injury, and infectious complications, including bar infection, pneumonia, or wound infection. The complication rate was mostly reported to be higher in adults [4,[7][8][9].…”

Section: Plos Onementioning

confidence: 99%

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The Nuss procedure for pectus excavatum: An effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients

Tzeng

Hsieh

et al. 2020

PLoS ONE

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The Nuss procedure is a minimally invasive repair used to treat pectus excavatum. A bilateral thoracoscopy-assisted approach has been reported as a safe method for Nuss repair. The aim of this observational cohort study is to evaluate the application of the bilateral thoracoscopy-inspection to assist in the selection of the number of bars for correction of the pectus deformity in adolescents and adults. A retrospective chart review was performed on all adolescent and adult patients (296 patients: 257 male, 39 female; aged of 23.9 ± 7.7 years) with pectus excavatum primarily corrected with the modified Nuss repair from August 2014 to January 2018. The patients were divided into three age groups (A: 12 years ≦ age < 19 years, n = 73; B: 19 years ≦ age < 30 years, n = 175; C: age ≧ 30 years, n = 48). Advanced repair of deformed chest walls using more than one bar depended on the change detected via gross and perioperative thoracoscopy-inspection. The results showed that two or three pectus bars were used in 268 patients (90.5%). The overall complication rate after a postoperative follow-up of 28.6 ± 11 months was 6.8% (20/296), without mortality, major bleeding, or serious infectious complications. A multivariate logistic regression analysis showed that the complications were only associated with Haller index (adjusted OR = 1.2935, p = 0.0317) under controlling confounding factors. The postoperative sternovertebral distance was significantly improved from 7.3±1.6 to 10.1± 2.8 cm (p<0.001). The thoracoscopy-assisted approach of Nuss repair for correction of pectus excavatum was safe and effective approach and could also be used as an alternative approach for the selection of placed bars in adolescent and adult patients. Further studies regarding long-term outcomes are required.

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Section: Plos Onementioning

confidence: 99%

“…Cardiac injury is the most serious complication. To avoid cardiac injury during operation, some techniques to force sternal elevation (such as crane technique) were illustrated [5,25]. Since we used bilateral thoracoscopic surgery to increase the safety of the procedure, the crane technique was used in only 12 procedures.…”

Section: Plos Onementioning

confidence: 99%

The Nuss procedure for pectus excavatum: An effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients

Tzeng

Hsieh

et al. 2020

PLoS ONE

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“…Protocols to treat deep bar infections are effective at retaining the bar in >85% of patients with a deep bar infection. 14,15 Late hemothorax occurred in 2 patients. Both were of unknown etiology, and presented with shortness of breath.…”

Section: Resultsmentioning

confidence: 99%

“…Only 2 (0.2%) patients required early bar removal, and this has not occurred since 2010. Protocols to treat deep bar infections are effective at retaining the bar in >85% of patients with a deep bar infection 14,15 …”

Section: Resultsmentioning

confidence: 99%

Recent Modifications of the Nuss Procedure

et al. 2020

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Objective: To review standardized Nuss correction of pectus excavatum and vacuum bell treatment over the last 10 years. Summary of Background Data: In 2010, we reported 21 years of the Nuss procedure in 1215 patients. Methods: Over the last 10 years, 2008-2018, we evaluated 1885 pectus excavatum patients. Surgery was indicated for well-defined objective criteria. A consistent operation was performed by 8 surgeons in 1034 patients, median 15 years, (range 6-46); 996 were primary, and 38 redo operations. Surgical patients' mean computed tomography index was 5.46. Mitral valve prolapse was present in 5.4%, Marfan syndrome in 1.1% and scoliosis in 29%. Vacuum bell treatment was introduced for 218 patients who did not meet surgical criteria or were averse to surgery. Results: At primary operation, 1 bar was placed in 49.8%; 2 bars, 49.4%; and 3 bars, 0.7%. There were no deaths. Cardiac perforation occurred in 1 patient who had undergone previous cardiac surgery. Paraplegia after epidural catheter occurred once. Reoperation for bar displacement occurred in 1.8%, hemothorax in 0.3%, and wound infection in 2.9%; 1.4% required surgical drainage. Allergy to stainless steel was identified in 13.7%. A good anatomic outcome was always achieved at bar removal. Recurrence requiring reoperation occurred in 3 primary surgical patients. Two patients developed carinate overcorrection requiring reoperation. Vacuum bell treatment produced better results in younger and less severe cases. Conclusions: A standardized Nuss procedure was performed by multiple surgeons in 1034 patients with good overall safety and results in primary repairs. Vacuum bell treatment is useful.

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“…Obermeyer and colleagues recently performed a single-center analysis of risk factors for Nuss bar infections; the cohort consisted of 781 patients, of which 25 (2.5%) developed a postoperative infection. The authors concluded that the rate of deep bar infection increased after perioperative clindamycin rather than cefazolin, while the rate of superficial infection increased with the use of peri-incisional subcutaneous catheters for analgesia ( 39 ).…”

Section: Pectus Excavatum Managementmentioning

confidence: 99%

The management of pectus excavatum in pediatric patients: a narrative review

Scalise¹,

Demehri²

2023

Transl Pediatr

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Background and Objective: Pectus excavatum is the most common congenital chest wall anomaly, the hallmark of which is the caved-in appearance of the anterior chest. A growing body of literature exists surrounding methods of surgical correction, though considerable variability in management remains. The primary objectives of this review are to outline the current practices surrounding the care of pediatric patients with pectus excavatum and present emerging trends in the field that continue to impact the care of these patients.

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Multivariate analysis of risk factors for Nuss bar infections: A single center study

Cited by 5 publications

References 11 publications

The Nuss procedure for pectus excavatum: An effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients

The Nuss procedure for pectus excavatum: An effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients

Recent Modifications of the Nuss Procedure

The management of pectus excavatum in pediatric patients: a narrative review

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