Patient Satisfaction After Minimally Invasive Repair of Pectus Excavatum in Adults: Long-Term Results of Nuss Procedure in Adults

Ann Thorac Surg. 2016 Apr;101(4):1338-45. doi: 10.1016/j.athoracsur.2015.09.102. Epub 2016 Jan 12.


Background: Extensive literature has proved that the Nuss procedure leads to permanent remodeling of the chest wall in pediatric patients with pectus excavatum (PE). However, limited long-term follow-up data are available for adults. Herein, we report a single-institution experience in the management of adult PE with the Nuss procedure, evaluating long-term outcomes and overall patient satisfaction after bar removal.

Methods: Adult patients who underwent PE repair with a modified Nuss procedure between January 1998 and June 2011 were retrospectively identified. Outcomes of interest were postoperative pain, recurrence, and patient satisfaction. A modified single-step Nuss questionnaire was administered to evaluate patient satisfaction and quality-of-life improvement after PE repair.

Results: Ninety-eight patients with a median age of 30.9 years (range, 21.8 to 55.1 years) at the time of repair were identified. One bar was placed in most patients (89.7%). Four patients (4.1%) required reoperation for bar displacement. Results after bar removal were overall satisfactory in 94.4% of patients; 2 patients required reoperation for recurrence. Thirty-nine patients participated in the survey. Satisfaction with chest appearance was reported by 89.7% of responders. Seven patients reported dissatisfaction with the overall results; the most common complaints were severe postoperative chest pain and dissatisfaction with surgical scars.

Conclusions: Favorable long-term results can be achieved with the Nuss procedure in adults. However, postoperative pain may require a more aggressive analgesic regimen, and it may be the overriding factor in the patient's perception of the quality of the postoperative course.

MeSH terms

  • Adult
  • Age Factors
  • Female
  • Follow-Up Studies
  • Funnel Chest / surgery*
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / adverse effects
  • Patient Satisfaction*
  • Postoperative Complications / epidemiology
  • Recurrence
  • Reoperation
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Young Adult