Quality-of-life outcomes after surgical correction of pectus excavatum: a comparison of the Ravitch and Nuss procedures

Lam, Mindy W.C.; Klassen, Anne F.; Montgomery, Carolyne J.; LeBlanc, Jacques G.; Skarsgard, Erik D.

doi:10.1016/j.jpedsurg.2007.12.020

Cited by 92 publications

(80 citation statements)

References 15 publications

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“…Furthermore, in a previous study, which included this control group, patients reported higher HRQL on all parameters after the surgery (17). This is incongruous with another study comparing patients after PE correction with norm samples (24). These results question the representation of the control sample included in this study.…”

Section: Discussioncontrasting

confidence: 86%

“…Body image has been found to be highly disturbed in patients with PE compared to controls in a previous study (7). It is hypothesized that an improvement in body image is related to an improvement in HRQL following surgery (24). We recommend that future studies include specific body-image measures to assess the patient's perception of his/her body image prior to surgery, and examine the link between body image and HRQL in order to determine which factor may contribute to improved HRQL after surgery.…”

Section: Discussionmentioning

confidence: 94%

“…Two studies have included generic HRQL measures to examine the generic HRQL in patients 1-1.5 years after surgery compared to controls or norm data. These studies showed mixed results with regard to HRQL after surgery, and the impact of the correction of the deformed chest on the patients' HRQL was not clarified as the studies were not prospective in design (17,24).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A prospective study on quality of life in youths after pectus excavatum correction

Lomholt

Jacobsen²,

Thastum

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The impact of correction of pectus excavatum (PE) on adolescents' health-related quality of life (HRQL) has only been investigated in prospective designs using disease-specific measures and without controls. The aim of this prospective study was to evaluate the HRQL before and after surgical correction of PE using a generic HRQL measure, and to compare the reported level of HRQL before surgery with an age-comparable control group.Methods: Patients (n=107) and one of their parents (n=106) completed the generic HRQL measure: the Child Health Questionnaire before, 3 months, and 6 months after correction for PE. A control group (n=183) consisting of school children comparable in age completed the same measure on one occasion. Results:The patients' level of HRQL before surgery was comparable to the level of the controls except for physical functioning; here boys reported impaired function compared to controls (P<0.0001, d=0.72).Both patients and parents reported improved emotional wellbeing and self-esteem, as well as an increase in physical and social activities from pre-to post-surgery. These improvements were statistically significant (P≤0.001-0.03) and yielded moderate to high effect sizes (ƞ 2 =0.04-0.22). Conclusions:The improvement of physical and psychosocial HRQL reported by both patients and their parents as proxy indicates the psychological implications of the deformity. Patients reported impaired physical function compared to controls. Further, pre-surgery differences in HRQL between the patients and the controls were lacking. However, the improvement in the patients' HRQL following surgery may justify the correction of pectus excavatum. The effect of the deformity on patients wellbeing compared with controls' needs to be addressed in further studies.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A prospective study on quality of life in youths after pectus excavatum correction

Lomholt

Jacobsen²,

Thastum

et al. 2016

Ann. Cardiothorac. Surg.

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“…Despite the fact that Kelly et al did not explicitly reference poor body image as an indication for repair, body image concerns constitute an important consideration in the pectus deformity patient population. Impairments in psychosocial functioning secondary to poor body image should be explored during the work-up of a pectus deformity patient, as surgical repair of pectus deformity may help to alleviate these concerns [12,[22][23][24]. There is currently no data evaluating the effects of regular psychiatric followup with a psychiatrist on alleviating the psychological burden of poor body image in this patient group.…”

Section: Indications For the Treatment Of Pectus Deformitymentioning

confidence: 99%

“…Proposed advantages to the minimally invasive Nuss procedure includes shorter operative times, minimal blood loss of less than 90 mL, immediate postoperative extubation, avoidance of instability of the chest wall, maintenance of chest wall elasticity and absence of a large surgical incision, making the Nuss procedure more suited to address psychosocial issues associated with pectus deformity [37,41,44,45]. Disadvantages of this minimally invasive repair includes considerable analgesic requirement, a challenging postoperative course in regards to pain control, increased length of hospitalization, and longer and more severe limitations in activity when compared with the open Ravitch procedure [2,4,23,45,46]. A significant reduction in forced vital capacity (FVC) on pulmonary function tests after implantation of the pectus bar has been reported (p < 0.001), which is theorized to be due to the transient postoperative functional restriction of respiratory movements of the thorax by the pectus bar [47].…”

Section: Newer Treatment Modalitiesmentioning

confidence: 99%

Advances in the management of pectus deformities in children

Swergold¹,

Sridharan²,

Loukas³

et al. 2013

OJPed

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Pectus excavatum (PE) and pectus carinatum (PC) are relatively common deformities involving the anterior chest wall, occurring in 1:1000 and 1:1500 live births, respectively. While the etiology remains an enigma, the association of pectus deformities with other skeletal abnormalities suggests that connective tissue disease may play a role in their pathogenesis. Clinical features of these deformities vary with severity, as determined by the Haller index and Backer ratio, but frequently include cardiac and respiratory abnormalities. Importantly, there exist profound psychosocial implications for children afflicted with these deformities, including but not limited to feelings of embarrassment and maladaptive social behaviors. These debilitating characteristics have prompted the development of novel medical and surgical corrective techniques. The correction of pectus deformities reduces the incidence of physiological complications secondary to chest wall malformation, while simultaneously improving body image and psychosocial development in the affected pediatric population. The Ravitch (open) and Nuss (minimally invasive) procedures remain the most frequently employed methods of pectus deformity repair, with no difference in overall complication rates, though individual complication rates vary with treatment. The Nuss procedure is associated with a higher rate of recurrence due to bar migration, hemothorax, and pneumothorax. Postoperative pain management is markedly more difficult in patients who have undergone Nuss repair. Patients undergoing the Ravitch procedure require less postoperative analgesia, but have longer operation times and a larger surgical scar. The cosmetic results of the Nuss procedure and its minimally invasive nature make it preferable to the Ravitch repair. Newer treatment modalities, including the vacuum bell, magnetic mini-mover procedure (3MP), and dynamic compression bracing (DCB) appear promising, and may ultimately provide effective methods of noninvasive repair. However, these modalities suffer from a lack of extensive published evidence, and the limited number of studies currently published fail to adequately define their long-term effectiveness.

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Comparison of magnetic resonance imaging and computed tomography to measure preoperative parameters of children with pectus excavatum

Sun

Chen

Peng

et al. 2019

Pediatric Investigation

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Importance Pectus excavatum (PE) is the most common thoracic wall deformity in children, we need a method which could be used to evaluate pulmonary functions and effects on development. Objective To evaluate the use of 3D T1‐weighted (3DT1) and mDIXON magnetic resonance imaging (MRI) sequences for measuring the thoracic parameters and morphology of children with PE, comparing the measurements with those made on computed tomography (CT). Methods This is a retrospective study of children with thoracic deformities who were hospitalized at the Department of Thoracic Surgery of the Heart Center, Beijing Children's Hospital, between June 2014 and June 2015. Chest CT was performed first, with the MRI scanning then being performed 0–3 days later. The mDIXON sequences were obtained in inspiratory and expiratory phases and the 3DT1 sequences were obtained during free breathing. Thoracic volume was measured using the acquired images. Results The lung volumes measured on mDIXON MRI and CT were highly correlated, with the Haller index not being significantly different between the two methods. Bland‐Altman analyses showed that lung, cardiac, and retrosternal parameters were similar between the two methods. Pulmonary parameters were higher with the end‐inspiratory phase mDIXON images than with the end‐expiratory phase images, as expected, while cardiac parameters were unaffected by the respiratory phase. Interpretation Thoracic volumes measured on mDIXON MRI in combination with held respiration could reflect lung volume functions and help in observing the movement functions of the lungs and heart. The method could be used instead of CT, avoiding subjecting the patient to potentially harmful radiation.

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Quality-of-life outcomes after surgical correction of pectus excavatum: a comparison of the Ravitch and Nuss procedures

Cited by 92 publications

References 15 publications

A prospective study on quality of life in youths after pectus excavatum correction

A prospective study on quality of life in youths after pectus excavatum correction

Advances in the management of pectus deformities in children

Comparison of magnetic resonance imaging and computed tomography to measure preoperative parameters of children with pectus excavatum

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