Long term results in children underwent nuss procedure preschool with pectus excavatum: Real-world study with propensity matching
Quan Wang1, Xiangpan Kong2, Chunian Ren1
1Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China.
Insights
Performing the Nuss procedure for pectus excavatum (PE) in young children (4-6 years) leads to a better hospital experience without impacting long-term satisfaction or recurrence rates compared to older children (12-14 years).
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Malformations
Background:
- Pectus excavatum (PE) is a congenital chest wall deformity with debated optimal surgical timing.
- The Nuss procedure is a common surgical correction for PE in children.
Purpose of the Study:
- To compare the long-term outcomes of the Nuss procedure in PE patients operated on at different ages.
- To evaluate patient satisfaction, recurrence rates, hospital stay, and analgesic requirements.
Main Methods:
- Retrospective analysis of 178 PE patients undergoing the Nuss procedure.
- Comparison between early (4-6 years) and late (12-14 years) surgical groups.
- Propensity score matching (PSM) was used to minimize bias between groups.
Main Results:
- Younger patients (4-6 years) required significantly less oral analgesia and had shorter hospital stays.
- No significant differences were observed in overall patient satisfaction (89.1% vs. 88.2%) or recurrence rates (7.2% vs. 6.8%) at age 18.
- Propensity score matching confirmed these findings, indicating similar long-term prognoses.
Conclusions:
- Early surgical intervention (4-6 years) for pectus excavatum via the Nuss procedure is safe and effective.
- Performing the Nuss procedure at a younger age offers a better immediate postoperative experience without compromising long-term results.
- Age at surgery does not significantly influence long-term satisfaction or recurrence in pectus excavatum patients.
Background:
It is controversial when surgery should be performed for pectus excavatum (PE). The study retrospectively compared the long-term prognosis in PE children undergoing the Nuss procedure at the age of 4-6 versus those performing surgery at the age of 12-14.
Methods:
178 patients were included in the retrospective real-world research. Clinical Characteristics were collected at baseline. The endpoint of the study was set as the last follow-up at the age of 18 in outpatient services. Satisfaction and complication rate were set as the primary outcome and were collected at the endpoint. Hospital stay post-surgery and analgesia dosage were regard as the secondary outcome. To reduce potential bias between two different age groups, propensity score matching (PSM) analysis was analysized.
Results:
The oral analgesic dosage of children in the 4-6 years old age group is significantly lower than that of the 12-14 years old group (0.70/kg, 0.30-1.50/kg versus 1.50/kg, 0.90-2.30/kg, P < 0.001), and children in the younger age group are discharged earlier. There was no difference in overall satisfaction (89.1 %, versus 88.20 %, P = 0.99) and recurrence rate (7.2 %, versus 6.8 %, P = 0.99) between the two groups of when they reach the age of 18.
Conclusions:
Performing Nuss procedure at the age of 4-6 does not affect the overall long-term satisfaction of the child or increase the long-term recurrence rate. Surgical intervention in children with pectus excavatum preschool can provide a better postoperative experience in hospital compared with intervention in adolescent.
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