A cross-sectional study for the development of growth of patients with pectus excavatum

Pectus excavatum is one of the most common congenital chest wall deformities, and is thought to be one of the musculoskeletal diseases. There have been few studies on the development of growth of patients with pectus excavatum. The objectives of the present study were to present the development of growth of patients with pectus excavatum and to investigate the effects of the Nuss procedure on the development of growth.

Data from 1371 patients who were treated for pectus excavatum (411 patients for only the Nuss procedure, 316 patients for only bar removal and 322 patients for both the Nuss procedure and the bar removal) at the Department of Thoracic and Cardiovascular Surgery in a single tertiary Korean Hospitals from March 2011 to December 2014 were assessed with respect to body measurements [height, weight and body mass index (BMI)]. Anthropometric measurements and developmental data and deviations of a reference population were analysed by the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-3), 2011-2013, Korea Centers for Disease Control and Prevention. To analyse the development of growth in patients with pectus excavatum, we performed (i) comparisons of body measurements between patients with pectus excavatum and the normal population, (ii) analyses of postoperative changes in the body measurements and (iii) analyses of the body measurements with respect to age at surgery, morphology and severity.

(i) Body measurements of the preoperative group (PreG, patients for the Nuss procedure) were significantly smaller than those of the normal control group (NCG) (height 139.2 ± 0.4 vs 140.7 ± 0.0, weight 37.4 ± 0.3 vs 39.6 ± 0.0, BMI 17.5 ± 0.1 vs 18.6 ± 0.0, all P < 0.001). Weight and BMI of the postoperative group (PostG, patients for pectus bar removal) were also significantly smaller than those of NCG (weight 36.6 ± 0.4 vs 39.6 ± 0.0, BMI 17.4 ± 0.1 vs 18.6 ± 0.0, both P < 0.001). However, height of PostG was not significantly different from that of NCG. In addition, height and BMI of PostG were larger than those of PreG (height 131.2 ± 0.3 vs 130.4 ± 0.3, P < 0.001; BMI 16.7 ± 0.1 vs 16.6 ± 0.1, P = 0.143). However, weight of PostG was significantly smaller than that of PreG (30.4 ± 0.2 vs 30.9 ± 0.2, P = 0.005). (ii) The severity of pectus excavatum was defined by the Haller index and the patients were divided into two groups by the mean value of the Haller index (4.3 ± 1.53). Preoperatively, weight and BMI of the high severity group (HG) were significantly smaller than those of the low severity group (LG) (weight 28.2 ± 0.3 vs 29.1 ± 0.2, P = 0.029; BMI 16.2 ± 0.1 vs16.6 ± 0.1, P = 0.008); however, height of HG was not significantly different from that of LG. Postoperatively, body measurements of HG were not significantly different from those of LG. In addition, severity of pectus excavatum was not correlated to age. (iii) Preoperatively, body measurements of the symmetric group (SG) were not different from those of the asymmetric group (AG). However, asymmetric type was more common in the older group (10.8 ± 5.7 vs 6.7 ± 5.0 years, P < 0.001). In addition, body measurements of SG were not different from those of AG postoperatively. (iv) Body growth after the surgery was more prominent in the early (age <10 years: height 112.4 ± 0.3 vs113.1 ± 0.4, P = 0.016, weight 20.2 ± 0.1 vs 20.2 ± 0.3, P = 0.053, BMI 15.7 ± 0.2 vs 15.8 ± 0.1, P = 0.007) than the late operation group (age ≥10 years: height 167.7 ± 0.5 vs 167.0 ± 0.6, P < 0.001, weight 51.2 ± 0.5 vs 51.8 ± 0.5, P = 0.536, BMI 18.1 ± 0.1 vs 18.3 ± 0.1, P = 0.078).

Development of growth in patients with pectus excavatum is retarded and appears to be related to the severity of pectus excavatum. The development of growth can be recovered by early correction of the deformity.