Long-term recurrence rates and patient satisfaction after repair of pectus excavatum.

Abstract

Pectus excavatum deformities are usually repaired with a minimally invasive approach in which a metal bar is used to correct the chest wall abnormality. We aimed to evaluate long-term outcomes and patient satisfaction after surgical correction. Patients who underwent pectus excavatum repair and subsequent bar removal at a single tertiary care center from January 2000 to December 2020 were identified. A retrospective chart review was performed, and a telephone survey was conducted to evaluate perceived inward chest movement, need for surgeon re-evaluation, surgical re-intervention, and overall satisfaction. Data are presented as medians with interquartile ranges (IQR) and frequencies with percentages. A total of 583 patients were included. The survey response rate was 26.2% (n=153). The respondents were predominantly male (80.4%, n=123) with a median age at surgical correction of 14.9 years (IQR 12.9,16.1) and a median Haller index of 3.8 (IQR 3.4,4.5). Median time to bar removal was 2.9 years (IQR 2.5,3.0) with a median age at removal of 17.7 years (IQR 15.5,19.0). Median time from surgery to survey follow-up was 9.6 years (IRQ 5.0, 11.4) with respondents having a median age at follow-up of 25 years (IQR 22.0, 28.4). The satisfaction rate was 96.7% (n=148) with a re-intervention rate of 2.0% (n=3). The perceived inward chest movement was 30.7% (n=47) with 12.8% (n=6) of those requesting surgical re-evaluation. There is a high level of satisfaction many years after correction of pectus excavatum and bar removal. With the advent of cryoablative therapy since 2017, patient satisfaction improved by experience of less postoperative pain. Re-intervention rate is low despite some patients reporting a perceived chest wall inward movement.