1. Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review
- Author
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Allen L. Milewicz, Andres F. Espinoza, J. Ruben Rodriguez, Jed G. Nuchtern, Richard S. Whitlock, Sohail R. Shah, Centura R. Anbarasu, Jorge I. Portuondo, Shawn J. Stafford, Mark V. Mazziotti, Raphael C. Sun, Louis D. Le, Steven C. Mehl, and Paul K. Minifee
- Subjects
Sternum ,medicine.medical_specialty ,Retrospective review ,Pleural effusion ,business.industry ,medicine.disease ,Nuss procedure ,Surgery ,Postoperative Complications ,Treatment Outcome ,Suture (anatomy) ,Pectus excavatum ,Interquartile range ,Funnel Chest ,Statistical significance ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Haller index ,business ,Retrospective Studies - Abstract
Introduction The Nuss procedure is the most common and preferred operative correction of pectus excavatum. Surgeon preference and patient factors can result in variations in Nuss procedure technique. We hypothesize that certain techniques are associated with increased risk of complications. Materials and Methods We performed a single-center retrospective review of Nuss operations from 2016 to 2020. Variations in intraoperative techniques included sternal elevator (SE) use, number of bars placed, and usage of bilateral stabilizing sutures. Patient demographics, intraoperative data, and postoperative outcomes were reported as median with interquartile ranges or percentages. Statistical significance (p Results Two hundred and sixty-five patients were identified. Patients repaired with two bars were older with a larger Haller index (HI). Patient demographics were not significantly different for SE or stabilizing suture use. Placement of two bars was associated with significantly increased risk of readmission. Similarly, SE use was associated with increased risk of pleural effusion and readmission. Finally, the use of bilateral stabilizing sutures resulted in less frequent slipped bars without statistical significance. Conclusion Older patients with a larger HI were more likely to need two bars placed to repair pectus excavatum. Placement of multiple bars and SE use are associated with significantly higher odds of certain complications.
- Published
- 2021