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. 2024 Oct 18;10(20):e39477.
doi: 10.1016/j.heliyon.2024.e39477. eCollection 2024 Oct 30.

Long term results in children underwent nuss procedure preschool with pectus excavatum: Real-world study with propensity matching

Quan Wang  1 , Xiangpan Kong  2 , Chunian Ren  1 , Zhengxia Pan  1 , Chun Wu  1 , Hongbo Li  1 , Yonggang Li  1 , Gang Wang  1 , Jiangtao Dai  1
Affiliations

Long term results in children underwent nuss procedure preschool with pectus excavatum: Real-world study with propensity matching

Quan Wang et al. Heliyon. .

Abstract

Background: It is controversial when surgery should be performed for pectus excavatum (PE). The study retrospectively compared the long-term prognosis in PE children undergoing the Nuss procedure at the age of 4-6 versus those performing surgery at the age of 12-14.

Methods: 178 patients were included in the retrospective real-world research. Clinical Characteristics were collected at baseline. The endpoint of the study was set as the last follow-up at the age of 18 in outpatient services. Satisfaction and complication rate were set as the primary outcome and were collected at the endpoint. Hospital stay post-surgery and analgesia dosage were regard as the secondary outcome. To reduce potential bias between two different age groups, propensity score matching (PSM) analysis was analysized.

Results: The oral analgesic dosage of children in the 4-6 years old age group is significantly lower than that of the 12-14 years old group (0.70/kg, 0.30-1.50/kg versus 1.50/kg, 0.90-2.30/kg, P < 0.001), and children in the younger age group are discharged earlier. There was no difference in overall satisfaction (89.1 %, versus 88.20 %, P = 0.99) and recurrence rate (7.2 %, versus 6.8 %, P = 0.99) between the two groups of when they reach the age of 18.

Conclusions: Performing Nuss procedure at the age of 4-6 does not affect the overall long-term satisfaction of the child or increase the long-term recurrence rate. Surgical intervention in children with pectus excavatum preschool can provide a better postoperative experience in hospital compared with intervention in adolescent.

Keywords: Long-term results; Nuss procedure; Pectus excavatum; Preschool.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Details of surgical procedure: A: Guide to establish a tunnel; B: Guiding steel plates through tunnels; C: Steel plate achievement placed behind the sternum; D: Flipped steel plate; E: Fine adjustment of steel plate position; F: Suture incision.
Fig. 2
Fig. 2
Flow chart of the study: PSM: Propensity Score Matching.
Fig. 3
Fig. 3
Balance after Propensity Score Matching: PSM: Propensity Score Matching; SMD: Standard mean difference.
Fig. 4
Fig. 4
Satisfaction of Long-term follow-up: A: Preoperative thoracic deformity of a boy aged four years and six months; B: X-ray results after Nuss producer. C: Appearance and morphology during follow-up at the age of 18.
Fig. 5
Fig. 5
RCS between Haller index and OR of Satisfaction: The reference point (HR/OR = 1) was 3.47 of HI.
Fig. 6
Fig. 6
Subgroup analysis of long-term satisfaction between the two groups of children under different HI indices.
See this image and copyright information in PMC

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References

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