Abstract
Aim: In 1998, Donald Nuss suggested the insertion of a metal bar behind the sternum for pectus excavatum as a minimally invasive technique. However, data regarding the relation between the age of the patient and clinical results of repair is limited. Aim of this study is to compare the clinical results of Nuss surgery for pectus excavatum in different age groups, to point out the optimal range of age for this procedure.
 Material and Methods: From February 2012 to January 2020, data regarding 140 patients have been treated with Nuss surgery. We classified patients into three groups: patients younger than 15 years (group A), patients between 15 and 20 years (group B); and patients older than 20 years up to 40 years (group C) retrospectively. We evaluated patients' demographics, and compared results of surgery, duration of hospitalization and complication rates.
 Results: One hundred ten patients were male and 30 were female. Male patients, clinical symptomatic patients with dyspnea in the preoperative period were seen more frequently in patients with older age, and each were statistically significant (p:0.003). In the early 30-day postoperative period, no mortality was observed. The most frequent postoperative complications were observed in group C (40,9%), followed by group B (18,2%) and group A (9,6%)(p:0.007). In logistic regression analysis, postoperative complications increased significantly in patients older than 20 years (p:0.003). Brace therapy was performed for 2 cases in Group A for recurrence after bar removal which occurred in adolescant period.
 Conclusion: Nuss procedure can be recommended with low complication rates, short term hospitalization and high grade of success. Although the childhood period seems to be more suitable regarding the complications, surgery can be preferred with low recurrence rates in adolescant period.
Highlights
In 1998, Donald Nuss suggested the insertion of a metal bar behind the sternum for pectus excavatum as a minimally invasive technique[1]
We evaluated patients' demographics, and compared results of surgery, duration of hospitalization and complication rates
Brace therapy was performed for 2 cases in Group A for recurrence after bar removal which occurred in adolescant period
Summary
In 1998, Donald Nuss suggested the insertion of a metal bar behind the sternum for pectus excavatum as a minimally invasive technique[1]. Many articles have been published about this technique[2]. Data regarding the relation between the age of the patient and clinical results of repair is limited. Optimal age reported in the literature is between 12 and 16 years [3].many clinicians perform this technique in both younger patients and adults [4,5,6]. Operations in adults have been reported to have higher rates of complication rates [3]
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