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Changes in resting pulmonary function testing over time after the Nuss procedure: A systematic review and
Quan Wang1, Shulei Fan2, Chun Wu1
1Cardiothoracic surgery of Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; China international Science and Technology Cooperation base of Child development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Insights
The Nuss procedure for pectus excavatum initially depresses pulmonary function, but forced expiratory volume in 1s (FEV1) slightly improves at two years post-surgery. Further long-term studies are needed to confirm full recovery of lung function.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Pectus excavatum is a common congenital chest wall deformity in children.
- It often leads to impaired pulmonary function.
- The effectiveness of the Nuss procedure in restoring lung function remains debated.
Purpose of the Study:
- To evaluate changes in pulmonary function after the Nuss procedure.
- To analyze the impact of the Nuss procedure on lung function in pediatric patients.
Main Methods:
- Systematic literature search of MEDLINE, Embase, Cochrane, and PubMed.
- Included studies with pre- and post-operative pulmonary function tests (PFTs).
- Analyzed forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC); subgroup analyses by time and age.
Main Results:
- 13 studies with 465 participants were analyzed.
- Post-surgery FEV1 showed a slight increase (SMD 0.17, p=0.04), while FVC showed a non-significant decrease (SMD -0.18, p=0.14).
- A temporal relationship was observed, with FEV1 higher more than 2 years post-surgery (SMD 0.26, p=0.012).
Conclusions:
- The Nuss procedure initially depresses pulmonary function.
- FEV1 shows a slight improvement at two years post-surgery compared to baseline.
- Longer follow-up studies are necessary to determine if pulmonary function normalizes.
Background:
Pectus excavatum, the most common congenital chest wall deformity in pediatric patients, leads to pulmonary dysfunction. There is no consensus regarding the effectiveness of the Nuss procedure for recovering pulmonary function. In this meta- analysis, we focused on the changes that occur in pulmonary function after the Nuss procedure.
Methods:
We performed a literature search in the MEDLINE, Embase, Cochrane library and PubMed databases. The included studies were required to contain pulmonary function tests with results adjusted to predicted values both before and after the Nuss procedure. The key outcomes of interest in this analysis were pulmonary function measured as forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC). Subgroup analyses were performed based on time since surgery and the mean ages of the patients when they underwent surgery by forest plots and meta-regressions.
Results:
Thirteen studies involving 465 participants were included in this review. The standard mean difference (SMD) observed in FEV1 and FVC after surgery were 0.17 (95% CI, 0.01-0.33, p=0.04) and -0.18 (95% CI, -0.41-0.06, p=0.14), respectively. The overall meta-regression SMD of FEV1 and FVC by time since surgery were 1.21 (95% CI, 1.04-1.41, p=0.020) and 1.38 (95% CI, 1.05-1.83, p=0.027), respectively. We found evidence of a temporal relationship between time at which pulmonary function tests were performed after surgery and predicted FEV1 and FVC values. The SMD of FEV1 (0.26, p=0.012) was slightly higher in group evaluated more than 2year after initial surgery.
Conclusions:
Abnormal resting pulmonary functions tests performed prior to surgery showed an initial depression after surgery. The FEV1 of patients slightly increased at 2year post surgery compared with the baseline. Further studies with longer term follow-up are still needed to determine if pulmonary function could improve to normal after surgery.
Levels Of Evidence:
Level of evidence: 4 (based on lowest level of article analyzed in meta-analysis/systematic review).
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