Surgical Repair of Pectus Excavatum Markedly Improves Body Image and Perceived Ability for Physical Activity: Multicenter Study

Authors

Robert E. Kelly Jr., Eastern Virginia Medical School
Thomas F. Cash, Old Dominion University
Robert C. Shamberger, Harvard Medical School
Karen K. Mitchell, Eastern Virginia Medical School
Robert B. Mellins, Columbia UniversityFollow
M. Louise Lawson, Kennesaw State UniversityFollow
Keith Oldham, Medical College of Wisconsin
Richard G. Azizkhan, University of Cincinnati - Main CampusFollow
Andre V. Hebra, Medical University of South CarolinaFollow
Michael J. Goretsky, Eastern Virginia Medical School
Ronald J. Sharp, University of Missouri at Kansas CityFollow
George W. Holcomb III, University of Missouri at Kansas CityFollow
Walton K. T. Shim, Kapiolani Medical Center for Women and Children, Honolulu, HIFollow
Stephen M. Megison, University of Texas Southwestern Medical School
R. Lawrence Moss, Yale UniversityFollow
Annie H. Fecteau, University of TorontoFollow
Paul M. Colombani, John Hopkins UniversityFollow
Traci Bagley, Eastern Virginia Medical School
Amy Quinn, Eastern Virginia Medical School
Alan B. Moskowitz, Eastern Virginia Medical SchoolFollow

Document Type

Article

Publication Date

12-1-2008

Abstract

• Article

Surgical Repair of Pectus Excavatum Markedly Improves Body Image and Perceived Ability for Physical Activity: Multicenter Study

1. Robert E. Kelly Jr, MD^a,^b,
2. Thomas F. Cash, PhD^c,
3. Robert C. Shamberger, MD^d,
4. Karen K. Mitchell, RN^b,
5. Robert B. Mellins, MD^e,
6. M. Louise Lawson, PhD^b,^f,
7. Keith Oldham, MD^g,
8. Richard G. Azizkhan, MD^h,
9. Andre V. Hebra, MDⁱ,
10. Donald Nuss, MBChB^a,^b,
11. Michael J. Goretsky, MD^a,^b,
12. Ronald J. Sharp, MD^j,
13. George W. Holcomb III, MD^j,
14. Walton K. T. Shim, MD^k,
15. Stephen M. Megison, MD^l,
16. R. Lawrence Moss, MD^m,
17. Annie H. Fecteau, MDⁿ,
18. Paul M. Colombani, MD^o,
19. Traci Bagley, RN, BSN^b,
20. Amy Quinn, MS^b,
21. Alan B. Moskowitz, MS^b

+ Author Affiliations

1. ^aDepartments of Surgery
2. ^bPediatrics, Eastern Virginia Medical School, Norfolk, Virginia
3. ^cDepartment of Psychology, Old Dominion University, Norfolk, Virginia
4. ^dDepartment of Surgery, Harvard Medical School, Boston, Massachusetts
5. ^eDepartment of Pediatrics, Columbia University, New York, New York
6. ^fDepartment of Mathematics and Statistics, Kennesaw State University, Kennesaw, Georgia
7. ^gDepartment of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
8. ^hDepartment of Surgery, University of Cincinnati, Cincinnati, Ohio
9. ⁱDepartment of Surgery, Medical University of South Carolina, Charleston, South Carolina
10. ^jDepartment of Surgery, University of Missouri at Kansas City, Kansas City, Missouri
11. ^kDepartment of Surgery, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii
12. ^lDepartment of Surgery, University of Texas Southwestern Medical School, Dallas, Texas
13. ^mDepartment of Surgery, Yale University, New Haven, Connecticut
14. ⁿDepartment of Surgery, University of Toronto, Toronto, Ontario, Canada
15. ^oDepartment of Surgery, Johns Hopkins University, Baltimore, Maryland

Abstract

OBJECTIVE. This study evaluated changes in both physical and psychosocial quality of life reported by the parent and child after surgical repair of pectus excavatum.

METHODS. As part of a multicenter study of pectus excavatum, a previously validated tool called the Pectus Excavatum Evaluation Questionnaire was administered by the research coordinator, via telephone, to parents and patients (8–21 years of age) before and 1 year after surgery. Eleven North American children's hospitals participated. From 2001 to 2006, 264 patients and 291 parents completed the initial questionnaire, and 247 patients and 274 parents completed the postoperative questionnaire. Responses used a Likert-type scale of 1 to 4, reflecting the extent or frequency of a particular experience, with higher values conveying less-desirable experience.

RESULTS. Preoperative psychosocial functioning was unrelated to objective pectus excavatum severity (computed tomographic index). Patients and their parents reported significant positive postoperative changes. Improvements occurred in both physical and psychosocial functioning, including less social self-consciousness and a more-favorable body image. For children, the body image component improved from 2.30 ± 0.62 (mean ± SD) to 1.40 ± 0.42 after surgery and the physical difficulties component improved from 2.11 ± 0.82 to 1.37 ± 0.44. For the parent questionnaire, the child's emotional difficulties improved from 1.81 ± 0.70 to 1.24 ± 0.36, social self-consciousness improved from 2.86 ± 1.03 to 1.33 ± 0.68, and physical difficulties improved from 2.14 ± 0.75 to 1.32 ± 0.39. Ninety-seven percent of patients thought that surgery improved how their chest looked.

CONCLUSIONS. Surgical repair of pectus excavatum can significantly improve the body image difficulties and limitations on physical activity experienced by patients. These results should prompt physicians to consider the physiologic and psychological implications of pectus excavatum just as they would any other physical deformity known to have such consequences.