“When to Nuss? patient age as a risk factor for complications of minimally invasive repair of pectus excavatum: a systematic review and meta-analysis”

Coughlin, Arielle; Ahsanuddin, Sofia; Inglesby, Dani C.; Fox, Conner; Xu, Hope; Margulies, Ilana G.; Sayegh, Farah; Soudant, Céline; Sacks, Henry S.; Kaufman, Andrew; Taub, Peter J.

doi:10.1007/s00383-021-05049-z

Cited by 13 publications

(4 citation statements)

References 44 publications

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“…Performing the Nuss procedure has become the most widely used technique for the correction of PE in pediatric and adult populations [ 3 , 4 ]. This procedure brings the risk of lethal complications, although rare, such as lung, heart, or great vessel injury [ 12 , 13 ]. Major and minor complications have been reported with an incidence that varies between 2% and 20%, although the true incidence is unknown due to the underreporting of these cases [ 7 , 8 , 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiorespiratory arrest during and after nuss procedure: case report

Cujiño-Álvarez¹,

Torres-Salazar²,

Velásquez-Galvis³

2023

J Cardiothorac Surg

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Background Pectum excavatum is a congenital thoracic alteration that can present important physiological alterations depending on the severity of the case. The Nuss procedure is a minimally invasive technique for managing chest wall deformity, in which there is a risk of perioperative complications. Case presentation This article presents the case of a 16-year-old patient who underwent placement of a Nuss bar and suffered intraoperative and postoperative cardiorespiratory arrest. Conclusions it is important to consider the possible early and late complications scenarios as well as their treatment in patients with pectum excavatum scheduled for a Nuss procedure.

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Section: Discussionmentioning

confidence: 99%

Cardiorespiratory arrest during and after nuss procedure: case report

Cujiño-Álvarez¹,

Torres-Salazar²,

Velásquez-Galvis³

2023

J Cardiothorac Surg

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“…10 Furthermore, increased age is associated with an increased risk for complications. [4][5][6][7][8][9] Surgeons today are attempting to balance ease of repair, risk of complication, and possibility of recurrence with desire to have the bar in place near the conclusion of skeletal maturation. Our findings demonstrate that a more immature Schmeling-Kellinghaus stage consumes less inpatient and total ME/Kg than the more mature complements.…”

Section: Discussionmentioning

confidence: 99%

“…3 This is affecting an overall trend toward increasing age of correction despite evidence for less postoperative pain, decreased complication rates, shorter inpatient stay, and better cosmetic results when correction is performed at younger ages. [4][5][6][7][8][9][10][11][12][13] Nevertheless, what has been largely unexploited in the preoperative evaluation of adolescents and young adults with pectus excavatum (PE) is the underlying mechanism which drives variability in chest wall pliability-the chest wall's complex developmental process which begins the sixth week of gestation and concludes as late as the 3 rd decade of life. 14,15 As skeletal maturation occurs at different rates, a patient-specific approach to timing of correction is warranted.…”

Section: Introductionmentioning

confidence: 99%

Evaluating Skeletal Maturity at Time of Surgical Correction of Pectus Excavatum Based on Medial Clavicle Epiphyseal Ossification

Carter,

Prendergast,

Krauss

et al. 2023

The American Surgeon™

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Background Surgical correction of pectus excavatum (SCOPE) is dependent upon chest wall pliability with optimal timing prior to complete skeletal maturation. Measures of skeletal maturity are not readily available for operative planning; therefore, surgeons use age as proxy despite patient-specific rates of skeletal maturation. We aimed to determine whether preoperative skeletal maturity is associated with postoperative pain as surrogate for chest wall pliability. Methods Children ≤18 years who underwent SCOPE from 2020 to 2022 were retrospectively identified. Preoperative CT within 3 months of procedure was reviewed by 2 radiologists and 1 surgeon. Skeletal maturity was determined by Schmeling-Kellinghaus classification which stages secondary epiphyseal ossification of the medial clavicle. Inter-rater reliability was evaluated. Schmeling-Kellinghaus stage and postoperative pain were compared. Results Of twenty-eight records reviewed, 57% were Schmeling-Kellinghaus stage 1. High inter-rater reliability was identified (inter-radiologist: kappa = .95, P < .001, all raters: kappa = .78, P < .001). Median age at operation was 15.5 years (interquartile range: 14.8-16.0) and increased with skeletal maturity ( P < .001). When comparing stage 1 (n = 16) to >1 (n = 12), stage 1 had lower maximum pain scores ( P < .001), total morphine equivalents ( P < .001), and benzodiazepine use ( P < .001) after surgery. Conclusions The Schmeling-Kellinghaus classification system is a valid proxy of skeletal maturity that can be applied with high inter-rater reliability. SCOPE during stage 1 was found to have less postoperative pain and narcotic use than more mature stages. This is proof of concept that skeletal maturity should be considered when determining optimal timing of surgical correction. Future research will evaluate the impact of skeletal maturity on postoperative outcomes.

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“…After more than 20 years of development, minimally invasive surgery (Nuss procedure) has been accepted by many thoracic surgeons due to its advantages such as no cartilage removal, less trauma, short operation time, and ideal correction effects [8,9]. It is generally accepted that the Nuss procedure is suitable for PE patients aged 13-16 years [10]. The treatment of children with pectus excavatum at 3-6 years has little support [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of Subcutaneous Sternal Suspension in The Treatment of Pectus Excavatum

Jiang

Feng

et al. 2022

Preprint

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Background: Nuss procedure is rarely used in young children. The application of subcutaneous sternal suspension (SSS) in low-collar children solves this embarrassment. This study aims to compare the safety and feasibility of subcutaneous sternal suspension and Nuss operation in the treatment of pectus excavatum. Methods: 69 patients with pectus excavatum surgery from 2013 to 2022 were included. The patients were divided into two groups according to surgical method: SSS group and Nuss group. Comparing basic information and perioperative complications to evaluate the feasibility and safety of two groups. Results: 44 patients in Nuss group had removed steel bars and 4 patients in SSS group. The average age of the SSS group was significantly lower than that of the Nuss group (P=0.0001). There were no significant differences in other baseline information such as gender, Haller index, symmetry and comorbidities. The SSS group was better than the Nuss group in the comparison of blood loss(P=0.22), postoperative hospital stays(P=0.003), operation time(P=0.0001). There was no significant difference in the complications between the two groups. Conclusions: SSS surgery is more suitable for low-collar patients (3years old and above) because of the advantages fast recovery. Thus, this method requires longer follow-up to observe its long-term therapeutic effect.

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“When to Nuss? patient age as a risk factor for complications of minimally invasive repair of pectus excavatum: a systematic review and meta-analysis”

Cited by 13 publications

References 44 publications

Cardiorespiratory arrest during and after nuss procedure: case report

Cardiorespiratory arrest during and after nuss procedure: case report

Evaluating Skeletal Maturity at Time of Surgical Correction of Pectus Excavatum Based on Medial Clavicle Epiphyseal Ossification

Feasibility and Safety of Subcutaneous Sternal Suspension in The Treatment of Pectus Excavatum

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