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

• Published in: The Annals of thoracic surgery Vol. 101; no. 4; pp. 1338 - 1345
• Main Authors: Sacco Casamassima, Maria Grazia, MD, Gause, Colin, MD, Goldstein, Seth D., MD, Karim, Omar, MD, Swarup, Abhishek, MD, McIltrot, Kimberly, DPN, Yang, Jingyan, MHS, Abdullah, Fizan, MD, PhD, Colombani, Paul M., MD, MBA
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2016
• Subjects: Adult; Age Factors; Cardiothoracic Surgery; 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; Surgery; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2015.09.102

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.