Prospective Multicenter Study of Surgical Correction of Pectus Excavatum: Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection
Authors
Robert E. Kelly Jr., Eastern Virginia Medical School
Robert C. Shamberger, Harvard Medical School
Robert B. Mellins, Columbia UniversityFollow
Karen K. Mitchell, Eastern Virginia Medical School
M. Louise Lawson, Kennesaw State UniversityFollow
Keith Oldham, Medical College of Wisconsin
Richard G. Azizkhan, University of Cincinnati - Main CampusFollow
Andre V. Hebra, University of South Florida College of MedicineFollow
Donald Nuss, Eastern Virginia Medical School
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 New Haven Children’s HospitalFollow
Annie H. Fecteau, University of TorontoFollow
Paul M. Colombani, Johns Hopkins University Medical CenterFollow
Traci C. Bagley, Eastern Virginia Medical School
Alan B. MoskowitzFollow
Abstract
Background: Given widespread adoption of the Nuss procedure, prospective multicenter study of management of pectus excavatum by both the open and Nuss procedures was thought desirable. Although surgical repair has been performed for more than 50 years, there are no prospective multicenter studies of its management.
Study Design: This observational study followed pectus excavatum patients treated surgically at 11 centers in North America, according to the method of choice of the patient and surgeon. Before operation, all underwent evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, hospital complications, and perioperative pain. One year after completion of treatment, patients will repeat the preoperative evaluations. This article addresses early results only.
Results: Of 416 patients screened, 327 were enrolled; 284 underwent the Nuss procedure and 43 had the open procedure. Median preoperative CT index was 4.4. Pulmonary function testing before operation showed mean forced vital capacity of 90% of predicted values; forced expiratory volume in 1 second (FEV1), 89% of predicted; and forced expiratory flow during the middle half of the forced vital capacity (FEF25% to 75%), 85% of predicted. Early postcorrection results showed that operations were performed without mortality and with minimal morbidity at 30 days postoperatively. Median hospital stay was 4 days. Postoperative pain was a median of 3 on a scale of 10 at time of discharge; the worst pain experienced was the same as was expected by the patients (median 8), and by 30 days after correction or operation, the median pain score was 1. Because of disproportionate enrollment and similar early complication rates, statistical comparison between operation types was limited.
Conclusions: Anatomically severe pectus excavatum is associated with abnormal pulmonary function. Initial operative correction performed at a variety of centers can be completed safely. Perioperative pain is successfully managed by current techniques.
