Alvarez-Garcia Natalia, Ardigo Laura, Bellia-Munzon Gaston, Martinez-Ferro Marcelo
Department of Pediatric Surgery, Hospital Infantil Miguel Servet, Zaragoza, Aragon, Spain.
Department of Pediatric Surgery, Fundacion Hospitalaria Children's Hospital, Buenos Aires, Argentina.
Eur J Pediatr Surg. 2018 Oct;28(5):406-412. doi: 10.1055/s-0037-1606842. Epub 2017 Sep 28.
Complications of the Nuss procedure are well known. However, publications about intraoperative and postoperative complications of the bar removal procedure (BRP) are scarce. Are they uncommon, unknown, or underreported? Are we ready to face them?
This study aims to explore the profile of complications of the BRP, risk perception, and preventive actions undertaken by the Chest Wall International Group (CWIG) surgeons.
A 14-question online survey was posted to the members of the CWIG from February 1 to 28, 2016. A qualifying question was setup to ensure respondents performed Nuss' procedure/variations. Overall, 96.5% of respondents ( = 116) qualified.
Despite being experts in the field of chest wall surgery 62.5% of respondents had performed ≤ 100 BRP and only 37.5% ≥ 100 BRP. Intraoperative complications: Severe bleeding from the bar tunnel was experienced at least one time by 28% of respondents and other serious complications, even death, were reported by 12%. Major surgical maneuvers to treat complications (sternotomy, thoracotomy, life-support maneuvers) were implemented by 62% of the surgeons who had experienced acute complications. Postoperative complications: Overall they were experienced at least once by 73.5% of surgeons. Wound seroma was the most cited complication (42%), followed by pneumothorax (27.5%). Surprisingly, one in every four surgeons acknowledged not requesting a routine chest X-ray before patient discharge. Complications versus experience: The report of acute complications increased with cumulative experience: Close to 50% for surgeons with < 100 BRP and as high as 100% for surgeons with > 1,000 BRP. Prevention of complications: Although 64% of surgeons defined the BRP as of intermediate/high risk, most of them (61%) do not prepare the operating room accordingly (availability of blood products, cardiac surgical backup, and perfusionist support).
BRP complications are being underestimated and underreported. Publications do not reflect the real spectrum of complications, which includes life-threatening conditions, even death. Preoperative planning and preparation of the operating room should not be disregarded.
努氏手术的并发症广为人知。然而，关于钢板取出手术（BRP）术中及术后并发症的出版物却很稀少。它们是不常见、不为人知，还是报道不足呢？我们是否做好应对它们的准备了呢？
本研究旨在探讨BRP并发症的情况、风险认知以及胸壁国际组织（CWIG）外科医生采取的预防措施。
2016年2月1日至28日，向CWIG成员发布了一份包含14个问题的在线调查问卷。设置了一个资格问题，以确保受访者进行过努氏手术/其变体手术。总体而言，96.5%的受访者（n = 116）符合资格。
尽管是胸壁外科领域的专家，但62.5%的受访者进行的BRP手术≤100例，只有37.5%的受访者≥100例。术中并发症：28%的受访者至少经历过一次钢板隧道严重出血，12%的受访者报告了其他严重并发症，甚至包括死亡。62%经历过急性并发症的外科医生实施了治疗并发症的主要手术操作（胸骨切开术、开胸手术、生命支持操作）。术后并发症：总体而言，73.5%的外科医生至少经历过一次。伤口血清肿是最常被提及的并发症（42%），其次是气胸（27.5%）。令人惊讶的是，每四位外科医生中就有一位承认在患者出院前未常规要求进行胸部X光检查。并发症与经验：急性并发症的报告随着累积经验的增加而增加：BRP手术<100例的外科医生中近50%有报告，而BRP手术>1000例的外科医生报告率高达100%。并发症的预防：尽管64%的外科医生将BRP定义为中/高风险，但他们中的大多数（61%）并未相应地准备手术室（血液制品的可用性、心脏外科备用人员以及灌注师支持）。
BRP并发症被低估且报告不足。出版物并未反映并发症的真实范围，其中包括危及生命的情况，甚至死亡。术前规划和手术室准备不应被忽视。
