Complications related to the Nuss procedure: minimizing risk with operative technique

J Pediatr Surg. 2013 May;48(5):1044-8. doi: 10.1016/j.jpedsurg.2013.02.025.


Introduction: Pectus Excavatum (PEx) is the most frequent congenital chest wall deformity; surgical correction has a complication rate of 10%-50%. The purpose of this study was to evaluate outcomes in a recent cohort of pediatric patients from a single institution and investigate factors associated with complications.

Methods: A review of all patients with PEx treated with a Nuss procedure from 2003 to 2011 was performed. Complications included hemo/pneumothorax, infection, bar migration, and operative injury. Chi-square, Student's t-test, and logistic regression were performed.

Results: The study included 127 Nuss patients with a the median age of 15.2 years (5.4-18.7) and a mean Haller index of 4.2 (+1.6). The total complication rate was 26% and bar migration rate was 18%. The use of a stabilizer was associated with fewer overall complications (17% vs 41%,p=0.006), decreased reoperation (16% vs 41%,p=0.003), decreased readmission (15% vs 39%,p=0.004), and decreased bar migration rate (9% vs 36%,p=0.001) compared to patients without a stabilizer. On multivariate analysis, the use of a stabilizer (OR 0.18,p=0.011,95% CI 0.049-0.68) and the use of a pericostal suture (OR 0.19,p=0.03,95% CI 0.41-0.85) were associated with decreased rates of bar migration.

Conclusion: The use of a lateral stabilizer and pericostal sutures decreased complication and reoperation rates for the Nuss procedure.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Device Removal
  • Female
  • Foreign-Body Migration / epidemiology
  • Funnel Chest / surgery*
  • Hemothorax / epidemiology
  • Hemothorax / etiology
  • Humans
  • Male
  • Minimally Invasive Surgical Procedures
  • Orthopedic Fixation Devices* / adverse effects
  • Pleural Effusion / epidemiology
  • Pleural Effusion / etiology
  • Pneumonia / epidemiology
  • Pneumonia / etiology
  • Pneumothorax / epidemiology
  • Pneumothorax / etiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Prosthesis Implantation / methods*
  • Reoperation
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / etiology
  • Suture Techniques