Minimally invasive care for pectus carinatum

Pectus Carinatum (PC) is a chest wall difference characterised by protrusion of the anterior chest wall and is commonly treated by Dynamic Compression Bracing (DCB). Whereas bracing programs are traditionally characterized by direct physician and health ally involvement at regular follow-up appointments, we hypothesize that PC can be successfully treated without in-person clinical care.

With REB approval, we prospectively enrolled all patients with PC treated with DCB from 2018 to 2024 at a single center. These patients were assessed by a single provider and offered DCB from an independent medical orthotics company, Braceworks (Calgary, AB), that provided virtual support. Eligible patients were invited to complete 2 validated satisfaction survey tools. These results as well as demographic details, number of visits (virtual or in-person) and distance from hospital were analyzed.

We identified 72 eligible patients during the study period of whom 68 had reliable contact information. The male:female ratio was 62:6, mean age at first visit: 14.5 ± 1.5. The median distance to hospital was 28.5 km (range = 2.5-2403 km); 14 patients lived >200 km from hospital. More patients (55 %) chose an initial virtual visit and those that did trended towards living further from the hospital (270 km vs.112 km; p = 0.12). Most patients missed less than 2 h of school due to appointments (67 %). Eighteen patients completed their care without an in-person clinical visit; limited survey data revealed no difference in treatment satisfaction across groups.

Pectus Carinatum can be successfully managed with DCB without necessitating in-person clinical visits. Virtual-only care for PC minimizes the risks, cost and carbon emissions associated with travel and is a patient-centric option for some patients and families.