Safety and Efficacy of Suspension procedure compared with Nuss procedure in Pectus excavatum:A propensity score matching analysis

Abstract

Introduction：Suspensions operation is a minimally invasive surgical treatment in pectus excavatum recently. Process of suspensions does not need to enter the pleural cavity, and thus avoid the heart, pericardium or lung tissue damage to the greatest degree. Through this study, we developed suspensions operation as an alternative option for the treatment of pectus excavatum. Material and Methods: Of 104 pectus excavatum patients corrected with nuss procedure and suspensions between January 2016 and 2021. Propensity score matching (PSM) was performed for age, sex, Haller index involvement in a 1:1 ratio between the two group, the primary safety endpoint was the presence of surgical complications, and the primary efficacy endpoint was Haller index measured postoperatively in each group. Secondary endpoints were and hospital length of stay (LOS), duration of surgical procedure, and postoperative pain degree. Chi-square, Student t test or one-way analysis of variance (ANOVA) were used for comparison as appropriate. Results: There are no differences between Nuss and Suspension procedures in major surgical complications. The efficacy endpoint was measured 18 months after the procedure, presenting a similar efficiency after surgery, Haller index :[Nuss 3.3（2.6-3.7） and Suspension（2.8-3.7）postoperatively, P = .14], measured by CT scan .There are significant differences between Nuss and Suspension procedures in minor surgical complications, patients undergo suspension surgery required less surgical time (35 ±11 versus 75±22 minutes, P < .01) and had shorter LOM (2±1.6 versus 6±2.2days, P < .01) and hospital LOS (5±2.2 versus 2±1.5 days, P < .01). Evaluating the postoperative pain grade of each group, fewer patients with suspension have 4 Grade of pian [Suspension 7 (21.8%) versus Nuss 17(53.1%), P < .05]. Conclusion: In this propensity-matched score analysis, patients with pectus excavatum, both surgical approaches have the same reliable surgical safety and outcome, and the suspension approach has the advantage of being simpler, less risky, and less painful for the patient after surgery, making suspension surgery an option for minimally invasive orthopedic surgery in these patients.