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Dynamic Compression System versus Self-Adjustable Bracing for Pectus Carinatum: Clinical Outcomes and Cost Comparison
Sherif Emil1,2, Yseult Gibert2, Daphne Lew3
1Shriners Hospitals for Children Canada, Chest Wall Anomaly Centre, Quebec, Canada, Montreal.
Insights
A self-adjustable brace for pectus carinatum treatment showed similar success rates and duration compared to a pressure-guided brace. This finding offers a cost-effective alternative for bracing pectus carinatum.
Area of Science:
- Pediatric Orthopedics
- Thoracic Surgery
- Biomedical Engineering
Background:
- Pectus carinatum is commonly treated with bracing.
- Limited comparative studies exist on different bracing methods.
- This study evaluates brace type effectiveness for pectus carinatum.
Purpose of the Study:
- To compare outcomes of pressure-guided orthotist-adjusted braces versus simpler, self-adjustable braces for pectus carinatum.
- To determine if brace type impacts treatment success and duration.
- To assess cost-effectiveness of different bracing options.
Main Methods:
- Retrospective analysis of 241 pediatric patients treated between 2011-2021.
- Comparison of FMF Dynamic Compression System (DCS) brace with Trulife self-adjustable brace.
- Assessment of Pressure of Correction (POC) and bracing success rates.
Main Results:
- No significant difference in POC or bracing success rates between DCS (89%) and Trulife (93%) groups.
- Similar active bracing duration for both brace types.
- Trulife brace use resulted in significant cost savings (CAD 406,000.00).
Conclusions:
- Self-adjustable braces offer comparable outcomes to pressure-guided braces for pectus carinatum.
- Bracing success and duration are not significantly affected by brace type.
- Self-adjustable braces present a more cost-effective treatment option.
Background:
Bracing is the preferred treatment for pectus carinatum. However, few studies have compared outcomes of different bracing methods. We tested the hypothesis that the type of brace has no effect on outcomes.
Methods:
A retrospective study of children who underwent bracing during a 10-year period (2011-2021) at a multidisciplinary chest wall anomaly center was conducted. The characteristics and outcomes of patients treated with a pressure-guided orthotist-adjusted brace (FMF Dynamic Compression System [DCS]) were compared with those treated with a simpler, less costly, self-adjustable brace (Trulife). Pressure of correction (POC) was used to assess severity. A standardized follow-up protocol was used. Patients who were still in active bracing or had inadequate follow-up were excluded.
Results:
During the study period, 373 patients started bracing, with 241 (93.7% males) having sufficient data to assess outcomes (170 DCS, 71 Trulife). Bracing succeeded in 217 patients (90%). Of 24 patients who failed, the majority (17) were due to non-compliance. There were no significant differences in POC (DCS 5.27 ± 1.59 vs. Trulife 4.99 ± 1.62 psi, p = 0.219) or any other characteristics between the groups. Bracing success (DCS 89% vs. Trulife 93%, p = 0.329) and active bracing duration (5.41 ± 3.52 vs. 5.37 ± 4.28 months, p = 0.944) were similar between the two groups. Loss to follow-up was significantly higher in the Trulife group (40.7% vs. 23.7%). Use of the Trulife brace resulted in a cost savings of CAD 406,000.00.
Conclusion:
With the limitations of a retrospective study, a self-adjustable brace resulted in a similar success rate and bracing duration, when compared with a pressure-guided orthotist-adjusted brace, and was associated with substantial cost savings.
Level Of Evidence:
IV.
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