Abstract
BackgroundBar displacement is one of the most common and serious complications after the Nuss procedure. However, measurements of and factors affecting bar displacement have not been reported. The objectives of this study were to develop a decision model to guide surgeons considering repeat treatment and to estimate optimal cut-off values to determine whether reoperation to correct bar displacement is warranted.MethodsFrom July 2011 to August 2013, ninety bars were inserted in 61 patients who underwent Nuss procedures for pectus excavatum. Group A did not need surgical intervention and Group B required reoperation for bar displacement. Bar position was measured as the distance from the posterior superior end of the sternal body to the upper border of the metal bar on lateral chest radiographs. The bar displacement index (BDI) was calculated using D0 - Dx / D0 x 100 (D0: bar position the day after surgery; Dx: minimal or maximal distance of bar position on the following postoperative days). The optimal cut-off values of BDI warranting reoperation were assessed on the basis of ROC curve analysis.ResultsOf the 61 patients, 32 had single bars inserted whereas 29 had parallel bars inserted. There was a significant difference in age (14.0 ± 7.5 vs. 23.3 ± 12.0, p = 0.0062), preoperative Haller index (HI) (4.0 ± 1.1 vs. 5.0 ± 1.0, p = 0.033), and postoperative HI (2.7 ± 0.4 vs. 3.2 ± 0.5 p = 0.006) between the two groups. The optimal cut-off value of BDI was 8.7.ConclusionsWe developed a BDI model for surgeons considering performing reoperation after Nuss procedure. The optimal cut-off value of BDI was 8.7. This model may help surgeons to decide objectively whether corrective surgery should be performed. The main factors affecting the relationship between bar displacement and reoperation were age and preoperative HI.
Highlights
Bar displacement is one of the most common and serious complications after the Nuss procedure
There were no significant differences in sex, BMI, pectus excavatum type, or the number of bar insertions between Groups A and B (Table 2)
receiver operating characteristic (ROC) curve analysis showed that the cut-off value of bar displacement index (BDI) indicating a need for corrective surgery for bar displacement was 8.7
Summary
Bar displacement is one of the most common and serious complications after the Nuss procedure. Measurements of and factors affecting bar displacement have not been reported. Bar displacement is one of the most serious complications after the Nuss procedure. Incidence rates of bar displacement vary from 1.8 to 16.6 % [1,2,3,4,5]. Bar displacement may result in morphologic changes. Bar displacement can occur through the following three mechanisms: bar flipping, lateral sliding, and hinge point disruption [7]. Displacement of the pectus bar after surgery can be mild to severe.
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