Health-related quality of life in children and adolescents undergoing surgery for pectus excavatum

Abstract

Introduction: This study evaluated health-related quality of life (HRQoL) in children and adolescents undergoing cosmetic surgery for pectus excavatum (PE) compared to a group of healthy children.

Methods: The Intervention Group consisted of 172 children and adolescents undergoing surgery for PE between 2003 and 2005, aged 8-20 years; 86% were males. A postoperative follow-up study was conducted one to three years after surgery. None of the children had had the metal bar removed when they answered the questionnaires. The Control Group consisted of healthy schoolchildren (n=387), 201 females and 186 males (9-20 years).The generic health-related quality of life questionnaires, the Child Health Questionnaire CHQ-CF87 (child version), and CHQ-PF50 (parent version) were used in both groups. A Nuss assessment questionnaire modified for Adults (NQ-mA) and a single-step questionnaire (SSQ) on quality of life and health status were only used in the Intervention Group; these questionnaires also included questions about the remembered preoperative status. The response rates in the Intervention and Control Groups were 69% and 70%, respectively.

Results: The HRQol was significantly better in the Intervention Group compared to the Control Group in 9 out of 14 subscales (CHQ-CF 87): General Health (p<0.05), Physical Functioning, Self-Esteem, Emotional Role, Role Functioning-Physical (p<0.01) and Mental Health, Family Activities, Bodily Pain, Role Functioning-Behavioral (p<0.001). The scores of the children and the parents correlated well in all subscales (rho range from 0.19-0.55, p<0.05-0.001) except for the Role Functioning-Physical scale (rho=0.17). Significant differences between the parent and child scores were found in six scales. The children reported significantly lower scores in Global Behavior, Global Health, Behavior (p<0.05), Bodily Pain (p<0.01), and Mental Health (p<0.001). The parents reported significantly lower scores in the Self Esteem scale (p<0.01). Self-esteem and body concept scored significantly higher postoperatively (p<0.001) in NQ-mA and SSQ.

Conclusion: HRQol was significantly better in the Intervention Group compared to healthy controls at the same age. In five subscales Self-Esteem, Behavior, Emotional Role, Mental Health and Family Activities, the PE group had a better HRQoL.