Aim of the study:
The optimal age for correction of pectus excavatum with the Nuss procedure is debated. Recent publications suggest inferior results in prepubertal children although earlier correction was historically thought to be preferable. The majority of our corrections are done post puberty with good cosmetic results. Concerned that outcomes were poorer in prepubertal patients, we reviewed our 18-year experience.
Retrospective cohort study of patients under 13 years old who underwent treatment for pectus excavatum by the Nuss procedure. The indication was cosmetic in all cases. Patients records were scrutinized for Haller index, age (years), length of stay (days), complications, duration of bar placement (months), length of follow-up, cosmetic outcome (satisfactory or unsatisfactory) and need for further corrective surgery.
Ninety-two children underwent pectus repair during the period 1997-2015. Twenty-one (23%) patients were <13 years (14 male). Full information was available for 19. Median age at bar placement was 10years (7.8-12.5). Haller index was 4.2±0.8. One bar was placed in all patients. Length of stay post insertion was 7 days (5-15). Four patients (21%) experienced early complications: pneumothorax requiring chest drain (n=2; 10%), and pneumonia (n=1; 5%). Median duration of bar in situ was 24 months (23-33). Three patients experienced late complications: chronic wound infection (n=1; 5%), local reaction to implant (n=1; 5%) and pain (n=1; 5%).
Overall the operating surgeons felt the cosmetic result, after bar removal, was satisfactory in only 36% of patients (n=7). Follow-up was 19 months (2-48). Further corrective surgery was undertaken or being considered in 3 (16%) patients.
Outcomes in prepubertal children undergoing pectus bar placement for repair of pectus excavatum in our centre have been disappointing. Encouraging children (and their parents) to wait until after puberty for corrective surgery may be in their best long-term interest.