Risk factors and management of Nuss bar infections in 1717 patients over 25years

Obermeyer, Robert J.; Godbout, Erin; Goretsky, Michael J.; Paulson, James F.; Frantz, Frazier W.; Kuhn, M. Ann; Lombardo, Michele; Buescher, E. Stephen; Deyerle, Ashley; Kelly, Robert E.

doi:10.1016/j.jpedsurg.2015.10.036

Cited by 22 publications

(18 citation statements)

References 19 publications

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“…Obermeyer et al recently reported the Norfolk experience on infections following the Nuss operation in 1,717 patients over 25 years. 24 Interestingly, in the most recent 8 years of this report, 3.5% of their 854 patients developed cellulitis or infection which was significantly more than the 1.5% noted in an earlier report of 863 patients from 1987 to 2005. 25 Other publications have shown that wound infections are the most common complication following the Nuss operation.…”

Section: Discussioncontrasting

confidence: 47%

The Minimally Invasive Repair of Pectus Excavatum Using a Subxiphoid Incision

et al. 2016

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Several surgeons have documented outcomes following the Nuss operation. Most reports have described the use of thoracoscopy to avoid cardiac injury. Since 1999, our group has utilized a subxiphoid incision, allowing insertion of the surgeon's finger into the substernal space to help guide the bar across the mediastinum. Our initial experience has been reported and we are now reporting our entire experience to date. A retrospective review was conducted on all patients who underwent pectus excavatum repair using a subxiphoid incision from December, 1999 to September, 2015. During the study period, 554 repairs were performed. A total of 80% of the patients were male. The mean age was 14.3 years ± 3.1, the mean operating time was 52 minutes ± 17.4, the mean length of stay was 4.2 days ± 1.1, and the mean time to bar removal was 2.7 years ± 0.7. A total of 20 patients (3.6%) received two bars. No patients sustained cardiac injury or evidence of pericarditis. Postoperatively, 22 patients (4%) developed an infection, either cellulitis or a local abscess requiring incision and drainage and/or antibiotics. In four of these 22 patients, the wound infection developed after the bar had been removed. Only one patient required bar removal before 2 years due to an infection. A total of 12 patients required either repositioning of the bar due to rotation (4) or removal of a stabilizer due to chronic discomfort (8), 2 required early bar removal for chronic pain, and 1 patient developed a tension pneumothorax in the operating room. A recurrence has developed in two patients but neither patient has desired correction. In this relatively large series of patients, the addition of a subxiphoid incision to the technique has allowed for safe passage of the bar across the mediastinum to avoid cardiac injury during the Nuss operation.

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Section: Discussioncontrasting

confidence: 47%

The Minimally Invasive Repair of Pectus Excavatum Using a Subxiphoid Incision

et al. 2016

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“…Accordingly, it is essential to establish the impact of the severity of the deformation on cardiac anatomy and function, particularly among children and young adults because the surgical decision is challenging in these patients given the intraoperative risk and the relatively variable rates of infection, bar migration, and reoperation [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Exaggerated Interventricular Dependence Among Patients With Pectus Excavatum: Combined Assessment With Cardiac MRI and Chest CT

Deviggiano

Vallejos

Viña

et al. 2017

American Journal of Roentgenology

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“…Correction is performed primarily for cosmetic reasons and to ease any psychological strain that is associated with body image concerns [1–3]. To elevate the sternum one or more metal bars are placed substernally via small bilateral thoracic incisions under thoracoscopic guidance [4–6]. The bars subsequently remain in place for approximately three years.…”

Section: Introductionmentioning

confidence: 99%

Trace metal release after minimally-invasive repair of pectus excavatum

et al. 2017

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BackgroundSeveral studies have shown a high incidence of metal allergy after minimally-invasive repair of pectus excavatum (MIRPE). We postulated that MIRPE is associated with a significant release of trace metal ions, possibly causing the allergic symptoms.MethodsWe evaluated the concentration with chromium, cobalt and nickel in blood, urine and tissue in patients prior to MIRPE and in patients who underwent an explantation of the stainless-steel bar(s) after three years.ResultsOur study group consisted of 20 patients (mean age 19 years) who had bar explantation and our control group included 20 patients (mean age 16 years) prior to MIRPE. At the time of bar removal we detected significantly elevated concentrations of chromium and nickel in the tissue compared to patients prior to the procedure (p<0,001). We also found a significant increase in the levels of chromium in urine and nickel in blood in patients three years post MIRPE (p<0,001). Four patients temporarily developed symptoms of metal allergy, all had elevated metal values in blood and urine at explantation.ConclusionsMinimally-invasive repair of pectus excavatum can lead to a significant trace metal exposure.

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Risk factors and management of Nuss bar infections in 1717 patients over 25years

Cited by 22 publications

References 19 publications

The Minimally Invasive Repair of Pectus Excavatum Using a Subxiphoid Incision

The Minimally Invasive Repair of Pectus Excavatum Using a Subxiphoid Incision

Exaggerated Interventricular Dependence Among Patients With Pectus Excavatum: Combined Assessment With Cardiac MRI and Chest CT

Trace metal release after minimally-invasive repair of pectus excavatum

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