Time Heals: The Impact of Waiting Times on Pediatric Patients' Decisions to Decline Pectus Surgery

Hendrik van Braak; Sjoerd A de Beer; Matthijs W N Oomen; Sander Zwaveling; Joep P M Derikx; L W Ernest van Heurn; Justin R de Jong

doi:10.1016/j.jpedsurg.2025.162504

Time Heals: The Impact of Waiting Times on Pediatric Patients' Decisions to Decline Pectus Surgery

J Pediatr Surg. 2025 Nov;60(11):162504. doi: 10.1016/j.jpedsurg.2025.162504. Epub 2025 Aug 6.

Authors

Hendrik van Braak¹, Sjoerd A de Beer², Matthijs W N Oomen², Sander Zwaveling², Joep P M Derikx², L W Ernest van Heurn³, Justin R de Jong²

Affiliations

¹ Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands. Electronic address: h.vanbraak@amsterdamumc.nl.
² Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
³ Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands.

PMID: 40780423
DOI: 10.1016/j.jpedsurg.2025.162504

Abstract

Background: This study investigates the impact of waiting times, due to Covid-19, on patients' decisions to undergo surgery for pectus deformities.

Methods: We conducted a cross-sectional study of patients (>18 years) on the pectus surgery waitlist at the Amsterdam Pectus Centre. Patients were contacted in January 2025. Primary outcome was the proportion of patients still wanting surgery. Secondary outcomes included symptom progression, reasons and predictive factors for withdrawal (Ravitch surgery, age at waitlist entry, male sex, physical and psychosocial symptoms at waitlist entry). Predictive factors were analyzed using multivariable logistic regression.

Results: Of 141 contacted patients, 75.9 % (107/141) were included. Age at waitlist entry was 16.0 years (IQR 15.0-17.0). After an average wait of 56.6 months (SD 22.2), only 52.3 % (23/44) of pectus excavatum, 30.9 % (17/55) of pectus carinatum/arcuatum and 37.5 % (3/8) of flaring patients still wanted surgery. Reasons for withdrawal differed: pectus excavatum patients most often cited body acceptance, while pectus carinatum/arcuatum patients most frequently mentioned strength training. Patients who withdrew showed greater reductions in physical (69.6 % versus 25.9 %, P = 0.002) and psychosocial symptoms (95.2 % versus 53.8 %, P = 0.004) than patients still wanting surgery. Thirteen patients were treated conservatively while awaiting surgery, with a 35.5 % success rate. Age (OR = 0.53, 95 %-CI = 0.33-0.86, P = 0.01) and physical symptoms (OR = 0.37, 95 %-CI = 0.15-0.94, P = 0.04) at waitlist entry were predictors of withdrawal from surgery.

Conclusions: After prolonged waiting, 59.8 % of all patients withdrew from surgery, primarily due to body acceptance and physical development. Psychological counseling and strength training should be integrated into pectus care, particularly for young, asymptomatic patients.

Keywords: Body acceptance; COVID-19; Nuss procedure; Pectus carinatum; Pectus excavatum; Ravitch surgery; Waitlist.

MeSH terms

Adolescent
COVID-19* / epidemiology
Cross-Sectional Studies
Decision Making*
Female
Funnel Chest* / psychology
Funnel Chest* / surgery
Humans
Male
Netherlands
Pectus Carinatum* / psychology
Pectus Carinatum* / surgery
Time Factors
Waiting Lists*