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Complications related to the Nuss procedure: minimizing risk with operative technique
Sara C Fallon1, Bethany J Slater, Jed G Nuchtern
1Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Insights
The Nuss procedure for pectus excavatum can be improved with stabilizers and pericostal sutures. These techniques reduce complications, reoperations, and bar migration in pediatric patients.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Deformities
Background:
- Pectus Excavatum (PEx) is the most common congenital chest wall deformity.
- Surgical correction of PEx carries a significant complication rate, ranging from 10% to 50%.
Purpose of the Study:
- To evaluate outcomes in pediatric patients undergoing the Nuss procedure.
- To identify factors associated with surgical complications in PEx repair.
Main Methods:
- Retrospective review of 127 pediatric patients treated with the Nuss procedure between 2003 and 2011.
- Analysis of complications including hemo/pneumothorax, infection, bar migration, and operative injury.
- Statistical analysis using Chi-square, Student's t-test, and logistic regression.
Main Results:
- The overall complication rate was 26%, with a 18% bar migration rate.
- Use of a stabilizer was associated with significantly fewer overall complications (17% vs. 41%), reoperations (16% vs. 41%), readmissions (15% vs. 39%), and bar migration (9% vs. 36%).
- Multivariate analysis identified stabilizer use and pericostal sutures as protective factors against bar migration.
Conclusions:
- Lateral stabilizers and pericostal sutures are effective in reducing complication and reoperation rates for the Nuss procedure.
- These adjuncts improve outcomes for pediatric patients with Pectus Excavatum.
Introduction:
Pectus Excavatum (PEx) is the most frequent congenital chest wall deformity; surgical correction has a complication rate of 10%-50%. The purpose of this study was to evaluate outcomes in a recent cohort of pediatric patients from a single institution and investigate factors associated with complications.
Methods:
A review of all patients with PEx treated with a Nuss procedure from 2003 to 2011 was performed. Complications included hemo/pneumothorax, infection, bar migration, and operative injury. Chi-square, Student's t-test, and logistic regression were performed.
Results:
The study included 127 Nuss patients with a the median age of 15.2 years (5.4-18.7) and a mean Haller index of 4.2 (+1.6). The total complication rate was 26% and bar migration rate was 18%. The use of a stabilizer was associated with fewer overall complications (17% vs 41%,p=0.006), decreased reoperation (16% vs 41%,p=0.003), decreased readmission (15% vs 39%,p=0.004), and decreased bar migration rate (9% vs 36%,p=0.001) compared to patients without a stabilizer. On multivariate analysis, the use of a stabilizer (OR 0.18,p=0.011,95% CI 0.049-0.68) and the use of a pericostal suture (OR 0.19,p=0.03,95% CI 0.41-0.85) were associated with decreased rates of bar migration.
Conclusion:
The use of a lateral stabilizer and pericostal sutures decreased complication and reoperation rates for the Nuss procedure.
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