Academic performance in children with pectus excavatum: a real-world research with propensity score matching

Abstract

Background: The optimal timing of surgery for pectus excavatum (PE) is controversial. A large proportion of children will not undergo surgery before puberty. However, untimely surgery may lead to a decline in the children's social adaptation and competitiveness because the children have already developed psychological and physiological impairments due to PE at an early age. The study retrospectively compared the academic performance in PE children undergoing the Nuss procedure versus nonsurgical observation.

Methods: This retrospective real-world research study included 480 PE patients with definite surgical indications, in whom it was first recommended that they undergo surgery between the ages of 6 and 12 years old. Academic performance was collected at baseline and 6 years later. A generalized linear regression was calculated to screen the factors affecting the performance. A propensity score matching (PSM) analysis was conducted to reduce the potential for confounding factors between surgical and nonsurgical PE patients.

Results: Haller index (HI) and pulmonary function were recognized as factors affecting baseline performance according to the generalized linear regression. For PE children with surgical indications, their academic performance significantly declined after 6 years of nonsurgical observation (52.1% ± 17.1% versus 58.3% ± 16.7%, p = 0.042). The academic performance in the surgery group was better than that in the nonsurgery group 6 years after PSM (60.7% ± 17.7% versus 52.1% ± 17.1%, p = 0.008).

Conclusions: The severity of PE will affect the academic performance of children.For PE children with definite surgical indications between the ages of 6 and 12 years old, surgical intervention rather than nonsurgical observation is more conducive to the development of children's academic performance.

Keywords: Nuss procedure; academic performance; pectus excavatum.

Figure 1.

Flow chart of the study. PE, pectus excavatum; PSM, propensity score matching.

Figure 2.

Trend analysis between HI and academic performance at baseline. HI, Haller index. *p < 0.05.

Figure 3.

RCS between HI and academic performance at baseline. The reference point (HR/OR = 1) was 3.5. HI, Haller index.

Figure 4.

Subgroup analysis between age at baseline and academic performance at baseline in PE and healthy group. PE, pectus excavatum.

Figure 5.

Comparisons of performance ranking at baseline and endpoint in surgery and nonsurgery group.