Aim of the study: We compared the severity of the lesion and long term outcomes in patients who were treated with Nuss thoracoplasty with patients who had no treatment.
Methods: Hospital records of 140 patients referred for treatment of funnel chest from 2001 to 2016 were reviewed. Main indication for surgery was cosmetic appearance. Eighty-five (61%) patients underwent Nuss procedure and 55 (39%) received no treatment. Outcome was measured with Nuss, psychometric (SLC-90) and quality of life (SF-36) questionnaires and spirometry.
Results: In surgical patients male/female ratio was 75/10 and in non-treated patients 40/15 (p=0.02). Median age at surgery was 16 (IQR 15-17) years, patients with no treatment were evaluated at a median age of 14 (IQR 12-15) years. Median Haller index was 5.0 (IQR 4.0-6.5) in surgical patients and 3.2 (2.6-4.2) in non-treated patients (p<0.0001). At initial evaluation 33 (38%) surgical patients and 9 (16%) of non-treated were symptomatic (p=0.005). Spirometry values did not differ between surgical and non-treated patients. Median follow-up was 7.3 (IQR 3.6-11) years. Of surgical patients 40 (47%) and of non-treated 14 (26%) returned the questionnaire and of these 12 (30%) and 4 (29%) had spirometry. At follow-up questionnaire scores and the spirometry results did not differ statistically significantly between surgical and non-treated patients. Symptoms at initial evaluation were not related with scores at follow-up.
Conclusion: Children who underwent surgical treatment for funnel chest had more severe lesions, were more often symptomatic and of male gender than patients who received no treatment. Outcomes in surgical and non-treated patients were similar.
TABLE 1. Nuss evaluation, psychometric SLC-90, quality of life SF-36 questionnaires and spirometry at follow-up