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.
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.
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).
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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- Chest wall deformities in pediatric surgery.Surg Clin North Am. 2012; 92 (ix): 669-684
- Pectus excavatum: history, hypotheses and treatment options.Interact Cardiovasc Thorac Surg. 2012; 14: 801-806
- The operative treatment of pectus excavatum.Ann Surg. 1949; 129: 429-444
- A 10-year review of a minimally invasive technique for the correction of pectus excavatum.J Pediatr Surg. 1998; 33: 545-552
- Surgical interventions for treating pectus excavatum.Cochrane Database Syst Rev. 2014; 2014: CD008889
- Ravitch versus Nuss procedure for pectus excavatum: systematic review and meta-analysis.Ann Cardiothorac Surg. 2016; 5: 409-421
- Comparison of the Nuss versus Ravitch procedure for pectus excavatum repair: an updated meta-analysis.J Pediatr Surg. 2017; 52: 1545-1552
- General Thoracic Surgery Database Data Collection.2019 (Available at:)https://www.sts.org/registries-research-center/sts-national-database/general-thoracic-surgery-database/data-collectionDate accessed: January 15, 2020
- Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair.J Pediatr Surg. 2014; 49 (discussion 923): 919-923
- Pectus excavatum repair: experience with standard and minimal invasive techniques.J Pediatr Surg. 2001; 36: 324-328
- Minimally invasive repair of pectus excavatum: a single institution's experience.Surgery. 2001; 130 (discussion 657–659): 652-657
- Surgical treatment for pectus excavatum.J Korean Med Sci. 2003; 18: 360-364
- Reduced hospitalization cost for patients with pectus excavatum treated using minimally invasive surgery.Surg Endosc. 2003; 17: 1609-1613
- Comparing minimally invasive funnel chest repair versus the conventional technique: an outcome analysis in children.Plast Reconstr Surg. 2004; 114 (discussion 674–675): 668-673
- Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection.J Am Coll Surg. 2007; 205: 205-216
- Long-term surveillance comparing satisfaction between the early experience of Nuss procedure vs. Ravitch procedure.Korean J Thorac Cardiovasc Surg. 2012; 45: 308-315
- Quality-of-life outcomes after surgical correction of pectus excavatum: a comparison of the Ravitch and Nuss procedures.J Pediatr Surg. 2008; 43: 819-825
- Comparison of minimally invasive and modified Ravitch pectus excavatum repair.J Pediatr Surg. 2002; 37: 413-417
- When patients choose: comparison of Nuss, Ravitch, and Leonard procedures for primary repair of pectus excavatum.J Pediatr Surg. 2009; 44 (discussion 1118–1119): 1113-1118
- Thoracoscopic repair of pectus excavatum using different bar stabilizers versus open repair.Asian Cardiovasc Thorac Ann. 2014; 22: 187-192
- Analyzing outcomes of Nuss and Ravitch repair for primary and recurrent pectus excavatum in adults.Ann Thorac Surg. 2020; 110: 272-275
- Choosing between the modified Ravitch and Nuss procedures for pectus excavatum: considering the patients's perspective.Ann R Coll Surg Engl. 2016; 98: 581-585
- Life-threatening hemorrhage during removal of a Nuss bar associated with sternal erosion.Ann Thorac Surg. 2014; 98: 1104-1106
Published online: January 22, 2021
Accepted: December 15, 2020
© 2020 Elsevier Inc. All rights reserved.
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- 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.