Complications related to the Nuss procedure: Minimizing risk with operative technique

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• 作者：Sara C. Fallon ; Bethany J. Slater ; Jed G. Nuchtern ; Darrell L. Cass ; Eugene S. Kim ; Monica E. Lopez ; Mark V. Mazziotti ; ^{mvmazzio@texaschildrens.org}
• 关键词：Pectus excavatum ; Nuss procedure ; Minimally invasive
• 刊名：Journal of Pediatric Surgery
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：48
• 期：5
• 页码：1044-1048
• 全文大小：105 K

文摘

Introduction

Pectus Excavatum (PEx) is the most frequent congenital chest wall deformity; surgical correction has a complication rate of 10 % -50 % . The purpose of this study was to evaluate outcomes in a recent cohort of pediatric patients from a single institution and investigate factors associated with complications.

Methods

A review of all patients with PEx treated with a Nuss procedure from 2003 to 2011 was performed. Complications included hemo/pneumothorax, infection, bar migration, and operative injury. Chi-square, Student's t-test, and logistic regression were performed.

Results

The study included 127 Nuss patients with a the median age of 15.2 years (5.4-18.7) and a mean Haller index of 4.2 (+ 1.6). The total complication rate was 26 % and bar migration rate was 18 % . The use of a stabilizer was associated with fewer overall complications (17 % vs 41 % ,p = 0.006), decreased reoperation (16 % vs 41 % ,p = 0.003), decreased readmission (15 % vs 39 % ,p = 0.004), and decreased bar migration rate (9 % vs 36 % ,p = 0.001) compared to patients without a stabilizer. On multivariate analysis, the use of a stabilizer (OR 0.18,p = 0.011,95 % CI 0.049-0.68) and the use of a pericostal suture (OR 0.19,p = 0.03,95 % CI 0.41-0.85) were associated with decreased rates of bar migration.

Conclusion

The use of a lateral stabilizer and pericostal sutures decreased complication and reoperation rates for the Nuss procedure.