Cardiorespiratory fitness after correction of pectus excavatum: a systematic review with meta-analysis

Pectus excavatum or funnel chest is the most prevalent chest wall deformity. Surgical correction is the treatment of choice which is predominantly performed on children and adolescents, often with significant surgical complication rates. While correction is primarily pursued for aesthetic reasons, proponents argue that correction of the inward deformity alleviates compression of the heart, consequently enhancing cardiorespiratory fitness. This systematic review and meta-analysis aims to assess whether surgical correction of pectus excavatum yields improvements in cardiorespiratory fitness, quantified as maximal oxygen uptake ([Formula: see text]O₂max). A search of PubMed, Scopus, and Embase was conducted for studies evaluating the changes in [Formula: see text]O₂max/[Formula: see text]O₂peak following surgical correction of pectus excavatum. Systematic qualitative evaluation of the included studies utilized the Risk of Bias in Non-randomized Studies of Interventions tool. Quantitative assessment of intervention effect sizes was executed using a random-effects model, supplemented by meta-regression. Among the 1,598 screened studies, 15 non-randomized studies were included. Systematic qualitative assessment revealed serious or critical risk of bias in all included studies. Quantitative assessment identified systematic errors in outcome measurements in several studies. Following surgical correction, we found no statistically or clinically significant improvement in [Formula: see text]O₂max/[Formula: see text]O₂peak. Our findings highlight a lack of high-quality studies in this field of research. Our analysis could not demonstrate any significant physiological impacts resulting from PE correction. Future studies should adopt randomized controlled trial designs and implement rigorous testing protocols for [Formula: see text]O₂max/[Formula: see text]O₂peak. The outcome of this study should prompt a restrained and cautious approach in communicating enhancement of physiological effects arising from surgical correction of pectus excavatum.