Abstract
Background
There are conflicting reports in the literature comparing outcomes after open Ravitch
and minimally invasive Nuss procedures for pectus excavatum repair, and there is relatively
little data available comparing the outcomes of these procedures performed by thoracic
surgeons.
Methods
The 2010 to 2018 Society of Thoracic Surgeons General Thoracic Surgery Database was
queried for patients age 12 or greater undergoing open or minimally invasive repair
of pectus excavatum. Patients were stratified by operative approach. Multivariable
logistic regression was performed with a composite outcome of 30-day complications.
Results
A total of 1,767 patients met inclusion criteria, including 1,017 and 750 patients
who underwent minimally invasive pectus repair and open repair, respectively. Open
repair patients were more likely to be American Society of Anesthesiologists (ASA)
class III or greater (24% vs 14%; P < .001), have a history of prior cardiothoracic surgery (26% vs 14%; P < .001), and require longer operations (median 268 vs 185 minutes; P < .001). Open repair patients were more likely to require greater than 6 days of
hospitalization (18% vs 7%; P < .001), undergo transfusion (7% vs 2%; P < .001), and be readmitted (8% vs 5%; P = .004). After adjustment, open repair was not associated with an increased risk
of a composite of postoperative complications (odds ratio 0.99, 95% confidence interval
0.67–1.46). This finding persisted after propensity score matching (odds ratio 1.11,
95% confidence interval 0.74–1.67).
Conclusion
Pectus excavatum repair procedure type was not associated with the risk of postoperative
complications after adjustment. Further investigation is necessary to determine the
impact of pectus excavatum repair type on recurrence and patient reported outcomes,
including satisfaction, quality of life, and pain control.
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Article info
Publication history
Published online: January 22, 2021
Accepted:
December 15,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Complications after Ravitch versus Nuss repair of pectus excavatum: What if none of these techniques are the right one?SurgeryVol. 170Issue 2
- PreviewIt was with great interest that we read the article by Jawitz et al.1 However, a close review on our part compelled us to respond. The authors retrospectively compared complications between the Ravitch and the Nuss repair of pectus excavatum (PEX) and reported no statistical difference between these two approaches to thoracic remodeling surgery.
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