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Complication Rate of the Nuss Procedure in Adults and Pediatric Patients: National Database Analysis
Hamza Rshaidat1, Eliyahu Gorgov2, Micaela L Collins1
1Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Philadelphia.
Insights
Adults undergoing the Nuss procedure for pectus excavatum (PE) face higher risks of hemorrhagic complications and acute pain. Female patients, across all age groups, experience significantly greater complication rates compared to males.
Area of Science:
- Thoracic surgery
- Congenital chest wall defects
- Surgical outcomes research
Background:
- Pectus excavatum (PE) is the most common congenital chest wall anomaly, characterized by sternal and costal cartilage depression.
- Limited data exists on the outcomes of the Nuss procedure in adult patients with PE.
- Understanding demographic trends and complication rates is crucial for optimizing surgical care.
Purpose of the Study:
- To compare postoperative complication rates between pediatric and adult patients undergoing the Nuss procedure for PE.
- To analyze demographic trends, including age and sex, in relation to complication rates.
- To assess the incidence of acute and chronic postoperative pain in different patient groups.
Main Methods:
- Retrospective analysis of a global healthcare database (TriNetX) from 2004 to 2023.
- Identification of patients who underwent Nuss repair (CPT codes 21742, 21743).
- Subgroup analysis based on age (pediatric vs. adult) and sex, assessing 30-day and 90-day complications, and pain.
Main Results:
- Adult patients (>18 years) showed increased hemorrhagic complications (3% vs. 0.86%) and acute pain (55% vs. 39.1%) compared to pediatric patients (<18 years).
- Overall complication rates were higher in female patients (28.48%) than in male patients (21.7%).
- Female patients exhibited higher rates of respiratory complications (6% vs. 2.7%), chronic pain (5.2% vs. 2%), and hemorrhagic complications (6% vs. 0.97%) compared to males.
Conclusions:
- Adults undergoing the Nuss procedure for PE experience significantly higher postoperative pain and hemorrhagic complications than pediatric patients.
- Female patients consistently show higher complication rates across all age groups compared to male patients.
- These findings highlight the need for tailored perioperative management strategies based on age and sex.
Background:
Pectus excavatum (PE) is the most common congenital chest wall defect and is characterized by the inward displacement of the sternum and costal cartilages. To date, there are limited data on adult patients undergoing the Nuss procedure for PE. This study aimed to assess the complication rate between the pediatric and adult populations and assess the trends in demographics.
Methods:
Retrospective analysis was conducted using a global health care database, TriNetX. Current Procedural Terminology codes (21742, 21743) were used to identify all patients who underwent Nuss procedures in the years 2004 to 2023. The cohort was then subdivided on the basis of age and sex. These patients were assessed for 30-day and 90-day major and minor postoperative complications, as well as acute pain and chronic postoperative pain.
Results:
A total of 2843 patients who underwent Nuss repair were identified. Patients aged >18 years had increased hemorrhagic complications (3% vs 0.86% in patients aged <18 years; P < .001) and acute pain (55% in patients aged >18 years vs 39.1% in patients aged <18 years; P < .001). Overall complication rates were 28.48% in female patients and 21.7% in male patients (P = .0014). Female patients had higher rates of respiratory complications (6% vs 2.7% in male patients; P = .001), chronic pain (5.2% in female patients vs 2% in male patients; P < .001), and hemorrhagic complications (6% in female patients vs 0.97% in male patients; P = .0042).
Conclusions:
This study suggests that adults with PE experience significantly increased postoperative pain and hemorrhagic complications after the Nuss procedure when compared with the pediatric population. Female patients experience significantly higher complication rates when compared with male patients in all age groups.
