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10.01.2022 | Original Article

“When to Nuss? patient age as a risk factor for complications of minimally invasive repair of pectus excavatum: a systematic review and meta-analysis”

verfasst von: Arielle C. Coughlin, Sofia Ahsanuddin, Dani Inglesby, Conner Fox, Hope Xu, Ilana Margulies, Farah Sayegh, Celine Soudant, Henry S. Sacks, Andrew Kaufman, Peter J. Taub

Erschienen in: Pediatric Surgery International | Ausgabe 3/2022

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Abstract

Purpose

The optimal age for minimally invasive repair of pectus excavatum (MIRPE) is unclear; this study investigates the differences in complication rates among different age groups undergoing repair.

Methods

PubMed and Embase databases were searched from inception to October 2020. To assess age as a risk factor for complications, odds ratios from relevant studies were analyzed using the Mantel–Haenszel method with a random-effects model for younger vs older patients. Specific complication rates were compared between the two cohorts using a chi-squared test.

Results

Of the 4448 studies retrieved, 25 studies stratified complication data by age groups. From these studies, ten studies compared groups at ages < 18 and ≥ 18 and four studies compared ages < 20 and ≥ 20, and one study compared ages < 19 and ≥ 19. These fifteen studies reported on 5978 patients, with 1188 complications, for a complication rate of 19.87%. Older patients were more likely to have complications in a pooled analysis of studies comparing older vs younger patients (OR = 1.66, 95% CI = 1.28–2.14, heterogeneity I² = 49%). Specifically, older patients were significantly more likely to experience pneumothorax, pleural effusion, wound infection, bar displacement, and reoperations.

Conclusion

Increased age is a risk factor for complications of MIRPE. This supports repair of pectus excavatum prior to late adolescence.

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Aronson DC, Bosgraaf RP, van der Horst C, Ekkelkamp S (2007) Nuss procedure: Pediatric surgical solution for adults with pectus excavatum. World J Surg 31:26–29. https://doi.org/10.1007/s00268-005-0779-1CrossRefPubMed

Cierpikowski P, Rzechonek A, Błasiak P, Lisowska H, Pniewski G, Le Pivert P (2018) Surgical correction of pectus excavatum by the nuss procedure: A 15-year experience study. Adv Exp Med Biol 1047:31–40. https://doi.org/10.1007/5584_2017_121CrossRefPubMed

Davari HM, Rahim MM, Ershadi RM et al (2018) First iranian experience of the minimally invasive Nuss procedure for pectus excavatum repair: a case series and literature review. Iran J Med Sci 43:554–559

van Aalst JA, Phillips JD, Sadove AM (2009) Pediatric chest wall and breast deformities. Plast Reconstr Surg 124:38e–49e. https://doi.org/10.1097/PRS.0b013e3181aa0f3bCrossRefPubMed

Park HJ, Sung SW, Park JK, Kim JJ, Jeon HW, Wang YP (2012) How early can we repair pectus excavatum: the earlier the better? Eur J Cardiothorac Surg 42:667–672. https://doi.org/10.1093/ejcts/ezs130CrossRefPubMed

Barua A, Rao VP, Barua B, Majewski A (2012) Patient satisfaction following minimally invasive repair of pectus excavatum: single surgeon experience. J Surg Tech Case Rep 4:86–88. https://doi.org/10.4103/2006-8808.110253CrossRefPubMedPubMedCentral

Engum S, Rescorla F, West K, Rouse T, Scherer LR, Grosfeld J I(2000) Is the grass greener? Early results of the Nuss procedure. J Pediatr Surg 35:246–251; discussion 257–248. https://doi.org/10.1016/s0022-3468(00)90018-6

Choi S, Park HJ (2017) Complications after pectus excavatum repair using pectus bars in adolescents and adults: risk comparisons between age and technique groups. Interact Cardiovasc Thorac Surg 25:606–612. https://doi.org/10.1093/icvts/ivx162CrossRefPubMed

Nuss D, Kelly RE Jr, Croitoru DP, Katz ME (1998) A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 33:545–552. https://doi.org/10.1016/s0022-3468(98)90314-1CrossRefPubMed

10.

Aizawa T, Togashi S, Domoto T, Sasaki K, Kiyosawa T, Sekido M (2014) Modification of the Nuss Procedure: The Single-incision Technique. Plast Reconstr Surg Glob Open 2:e256. https://doi.org/10.1097/GOX.0000000000000225CrossRefPubMedPubMedCentral

11.

Boehm RA, Muensterer OJ, Till H (2004) Comparing minimally invasive funnel chest repair versus the conventional technique: an outcome analysis in children. Plast Reconstr Surg 114:668–673. https://doi.org/10.1097/01.prs.0000130938.87402.b0CrossRefPubMed

12.

Croitoru DP, Kelly RE Jr, Goretsky MJ, Lawson ML, Swoveland B, Nuss D (2002) Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg 37:437–445. https://doi.org/10.1053/jpsu.2002.30851CrossRefPubMed

13.

Esteves E, Paiva KC, Calcagno-Silva M, Chagas CC, Barbosa-Filho H (2011) Treatment of pectus excavatum in patients over 20 years of age. J Laparoendosc Adv Surg Tech A 21:93–96CrossRef

14.

Pawlak K, Gąsiorowski Ł, Gabryel P, Gałęcki B, Zieliński P, Dyszkiewicz W (2016) Early and late results of the nuss procedure in surgical treatment of pectus excavatum in different age groups. Ann Thorac Surg 102:1711–1716. https://doi.org/10.1016/j.athoracsur.2016.04.098CrossRefPubMed

15.

McLeroy KR, Northridge ME, Balcazar H, Greenberg MR, Landers SJ (2012) Reporting guidelines and the American Journal of Public Health’s adoption of Preferred Reporting Items for Systematic reviews and Meta-Analyses. Am J Public Health 102:780–784. https://doi.org/10.2105/AJPH.2011.300630CrossRefPubMedPubMedCentral

16.

OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine. Available at: http://www.cebm.net/index.aspx?o=5653. Accessed Aug 10, 2021

17.

Munn Z, Barker T, Moola S, Tufanaru C, et al (2020) Methodological quality of case series studies. JBI Evid Synth https://doi.org/10.11124/JBISRIR-D-19-00099

18.

Moola S, Munn Z, Tufanaru C, Aromataris E, et al (2020) Chapter 7: Systematic reviews of etiology and risk . In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI

19.

Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014

20.

Darlong LM (2013) Pectus tunneloscopy: making Nuss procedure for pectus excavatum safe. Interact Cardiovasc Thorac Surg 17:233–236. https://doi.org/10.1093/icvts/ivt206CrossRefPubMedPubMedCentral

21.

Erşen E, Demirkaya A, Kılıç B et al (2016) Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice? Wideochir Inne Tech Maloinwazyjne 11:98–104. https://doi.org/10.5114/wiitm.2016.60456CrossRefPubMedPubMedCentral

22.

Kim DH, Hwang JJ, Lee MK, Lee DY, Paik HC (2005) Analysis of the Nuss procedure for pectus excavatum in different age groups. Ann Thorac Surg 80:1073–1077. https://doi.org/10.1016/j.athoracsur.2005.03.070CrossRefPubMed

23.

Toci GR, Davis TA, Bigelow BF, Yang SC (2020) Analyzing outcomes of Nuss and Ravitch repair for primary and recurrent pectus excavatum in adults. Ann Thorac Surg 110:272–275. https://doi.org/10.1016/j.athoracsur.2019.12.012CrossRefPubMed

24.

Nagasao T, Morotomi T, Kuriyama M et al (2017) Thoracic outlet syndrome after the Nuss procedure for pectus excavatum: Is it a rare complication? J Plast Reconstr Aesthet Surg 70:1433–1439. https://doi.org/10.1016/j.bjps.2017.05.043CrossRefPubMed

25.

Hsieh MS, Tong SS, Wei BC, Chung CC, Cheng YL (2020) Minimization of the complications associated with bar removal after the Nuss procedure in adults. J Cardiothorac Surg 15:65. https://doi.org/10.1186/s13019-020-01106-1CrossRefPubMedPubMedCentral

26.

Tanaka K, Kuwashima N, Ashizuka S, Yoshizawa J, Ohki T (2012) Risk factors of infection of implanted device after the Nuss procedure. Pediatr Surg Int 28:873–876. https://doi.org/10.1007/s00383-012-3145-zCrossRefPubMed

27.

Nagaso T, Miyamoto J, Kokaji K et al (2010) Double-bar application decreases postoperative pain after the Nuss procedure. J Thorac Cardiovasc Surg 140(39–44):44.e31–32. https://doi.org/10.1016/j.jtcvs.2009.12.027CrossRef

28.

Uemura S, Nakagawa Y, Yoshida A, Choda Y (2003) Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar. Pediatr Surg Int 19:186–189. https://doi.org/10.1007/s00383-002-0915-zCrossRefPubMed

29.

Stanfill AB, DiSomma N, Henriques SM, Wallace LJ, Vegunta RK, Pearl RH (2012) Nuss procedure: decrease in bar movement requiring reoperation with primary placement of two bars. J Laparoendosc Adv Surg Tech A 22:412–415. https://doi.org/10.1089/lap.2011.0080CrossRefPubMed

30.

Cho DG, Kim JJ, Park JK, Moon SW (2018) Recurrence of pectus excavatum following the Nuss procedure. J Thorac Dis 10(11):6201–6210 https://doi.org/10.21037/jtd.2018.10.31

31.

Mao YZ, Tang ST, Wang Y et al (2009) Nuss operation for pectus excavatum: a single-institution experience. World J Pediatr 5:292. https://doi.org/10.1007/s12519-009-0055-9CrossRefPubMed

32.

Ohno K, Morotomi Y, Ueda M et al (2003) Comparison of the Nuss procedure for pectus excavatum by age and uncommon complications. Osaka City Med J 49(2):71–76PubMed

33.

Takanari K, Toriyama K, Kambe M et al (2019) Nuss procedure for patients with pectus excavatum with a history of intrathoracic surgery. J Plast Reconstr Aesthet Surg 72:1025–1029. https://doi.org/10.1016/j.bjps.2018.12.027CrossRefPubMed

34.

Petersen C, Leonhardt J, Duderstadt M, Karck M, Ure BM (2006) Minimally invasive repair of pectus excavatum - shifting the paradigm? Eur J Pediatr Surg 16(2):75–78. https://doi.org/10.1055/s-2006-924001CrossRefPubMed

35.

Jaroszewski DE, Ewais MM, Chao CJ et al (2016) Success of minimally invasive pectus excavatum procedures (modified nuss) in adult patients (≥30 years). Ann Thorac Surg 102(3):993–1003. https://doi.org/10.1016/j.athoracsur.2016.03.105CrossRefPubMed

36.

Cheng YL, Lee SC, Huang TW, Wu CT (2008) Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum. Eur J Cardiothorac Surg 34(5):1057–1061. https://doi.org/10.1016/j.ejcts.2008.07.068CrossRefPubMed

37.

Jaroszewski D, Notrica D, McMahon L, Steidley DE, Deschamps C (2010) Current management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med 23:230–239. https://doi.org/10.3122/jabfm.2010.02.090234CrossRefPubMed

38.

Nuss D, Croitoru DP, Kelly RE Jr, Goretsky MJ, Nuss KJ, Gustin TS (2002) Review and discussion of the complications of minimally invasive pectus excavatum repair. Eur J Pediatr Surg 12:230–234. https://doi.org/10.1055/s-2002-34485CrossRefPubMed

39.

Kelly RE, Goretsky MJ, Obermeyer R et al (2010) Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg 252:1072–1081. https://doi.org/10.1097/SLA.0b013e3181effdceCrossRefPubMed

40.

Olbrecht VA, Arnold MA, Nabaweesi R et al (2008) Lorenz bar repair of pectus excavatum in the adult population: should it be done? Ann Thorac Surg 86(2):402–408. https://doi.org/10.1016/j.athoracsur.2008.04.038CrossRefPubMed

41.

Chavoin JP, Grolleau JL, Moreno B et al (2016) Correction of pectus excavatum by custom-made silicone implants: contribution of computer-aided design reconstruction. A 20-year experience and 401 cases. Plast Reconstr Surg. https://doi.org/10.1097/PRS.0000000000002071CrossRefPubMed

42.

Fox JP, Schnell JL, Adams TA Jr, Hilton WM, Seyfer AE (2007) Pectus excavatum: comparison of nonprosthetic repairs using multiple techniques. Plast Reconstr Surg 119:33e–39e. https://doi.org/10.1097/01.prs.0000252400.13715.19CrossRefPubMed

43.

Lee YH (2018) An overview of meta-analysis for clinicians. Korean J Intern Med 33:277–283. https://doi.org/10.3904/kjim.2016.195CrossRefPubMed

44.

Sterne JA, Egger M, Smith GD (2001) Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis. BMJ 323(7304):101–105. https://doi.org/10.1136/bmj.323.7304.101CrossRefPubMedPubMedCentral

45.

Johnson WR, Fedor D, Singhal S (2014) Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum. J Cardiothorac Surg 9:25. https://doi.org/10.1186/1749-8090-9-25CrossRefPubMedPubMedCentral

46.

Kauffman JD, Benzie AL, Snyder CW, Danielson PD, Chandler NM (2019) Short-term outcomes after pectus excavatum repair in adults and children. J Surg Res 244:231–240. https://doi.org/10.1016/j.jss.2019.06.069CrossRefPubMed

47.

Knudsen MR, Nyboe C, Hjortdal VE, Pilegaard HK (2013) Routine postoperative chest X-ray is unnecessary following the Nuss procedure for pectus excavatum. Interact Cardiovasc Thorac Surg 16:830–833. https://doi.org/10.1093/icvts/ivt052CrossRefPubMedPubMedCentral

48.

Lo PC, Tzeng IS, Hsieh MS, Yang MC, Wei BC, Cheng YL (2020) The Nuss procedure for pectus excavatum: An effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients. PLoS ONE 15:e0233547. https://doi.org/10.1371/journal.pone.0233547CrossRefPubMedPubMedCentral

Titel: “When to Nuss? patient age as a risk factor for complications of minimally invasive repair of pectus excavatum: a systematic review and meta-analysis”
verfasst von: Arielle C. Coughlin
Sofia Ahsanuddin
Dani Inglesby
Conner Fox
Hope Xu
Ilana Margulies
Farah Sayegh
Celine Soudant
Henry S. Sacks
Andrew Kaufman
Peter J. Taub
Publikationsdatum: 10.01.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 3/2022
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-021-05049-z

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“When to Nuss? patient age as a risk factor for complications of minimally invasive repair of pectus excavatum: a systematic review and meta-analysis”