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

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

  1. Robert E. Kelly Jr, MDa,b,
  2. Thomas F. Cash, PhDc,
  3. Robert C. Shamberger, MDd,
  4. Karen K. Mitchell, RNb,
  5. Robert B. Mellins, MDe,
  6. M. Louise Lawson, PhDb,f,
  7. Keith Oldham, MDg,
  8. Richard G. Azizkhan, MDh,
  9. Andre V. Hebra, MDi,
  10. Donald Nuss, MBChBa,b,
  11. Michael J. Goretsky, MDa,b,
  12. Ronald J. Sharp, MDj,
  13. George W. Holcomb III, MDj,
  14. Walton K. T. Shim, MDk,
  15. Stephen M. Megison, MDl,
  16. R. Lawrence Moss, MDm,
  17. Annie H. Fecteau, MDn,
  18. Paul M. Colombani, MDo,
  19. Traci Bagley, RN, BSNb,
  20. Amy Quinn, MSb,
  21. Alan B. Moskowitz, MSb

+ 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


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.