Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
J Surg Res. 2019 Dec;244:231-240. doi: 10.1016/j.jss.2019.06.069. Epub 2019 Jul 10.
Pectus excavatum is a common congenital chest wall deformity often repaired during adolescence, although a subset of patients undergo repair as adults. The goal of our study was to determine the effects of age at repair and repair technique on short-term surgical outcomes.
We performed a cohort study of patients in the 2012 to 2016 American College of Surgeons National Surgical Quality Improvement Project pediatric (age<18 y) and adult databases who underwent pectus excavatum repair. The primary outcome was the incidence of 30-d complications. Secondary outcomes included length of stay, reoperation, and readmission. Multivariable logistic regression was used to estimate the independent effects of patient age and type of repair on postoperative outcomes.
Of the 2268 subjects included, 2089 (92.1%) were younger than 18 y. Overall, 3.4% of patients suffered a 30-d complication, and the risk was similar between age groups (risk ratio [RR], 0.69; 95% confidence interval [CI], 0.08-5.03; P = 0.731). Steroid therapy was an independent risk factor for complications (RR, 8.0; 95% CI, 1.9-19.7; P = 0.006). Median length of stay was 4 d (interquartile range, 3-5) and was similar between age groups. Risk for readmission and reoperation were 2.8% and 1.5%, respectively, and were similar for pediatric and adult patients. When comparing minimally invasive repair with and without thoracoscopy, risk for 30-d complications was lower among patients repaired with thoracoscopy (RR, 0.56; CI, 0.32-0.96; P = 0.034).
Pediatric and adult patients experience comparable rates of postoperative complications, readmission, and reoperation after pectus excavatum repair. Use of thoracoscopy during minimally invasive repair is associated with lower risk of complications. These findings suggest that thoracoscopy should be used routinely for minimally invasive repair of pectus excavatum.
漏斗胸是一种常见的先天性胸廓畸形，通常在青少年时期进行修复，尽管有一部分患者在成年后进行修复。我们的研究目的是确定修复年龄和修复技术对短期手术结果的影响。
我们对 2012 年至 2016 年美国外科医师学会国家外科质量改进计划小儿（年龄<18 岁）和成人数据库中接受漏斗胸修复的患者进行了队列研究。主要结果是 30 天并发症的发生率。次要结果包括住院时间、再次手术和再入院。多变量逻辑回归用于估计患者年龄和修复类型对术后结果的独立影响。
在 2268 名受试者中，2089 名（92.1%）年龄小于 18 岁。总体而言，3.4%的患者发生 30 天并发症，且各年龄组之间的风险相似（风险比 [RR]，0.69；95%置信区间 [CI]，0.08-5.03；P=0.731）。类固醇治疗是并发症的独立危险因素（RR，8.0；95%CI，1.9-19.7；P=0.006）。中位住院时间为 4 天（四分位间距，3-5），各年龄组之间相似。再入院和再次手术的风险分别为 2.8%和 1.5%，小儿和成人患者相似。在比较微创修复与无胸腔镜的修复时，胸腔镜修复的患者 30 天并发症的风险较低（RR，0.56；CI，0.32-0.96；P=0.034）。
小儿和成年患者在接受漏斗胸修复后，术后并发症、再入院和再次手术的发生率相似。微创修复时使用胸腔镜与并发症风险降低相关。这些发现表明，胸腔镜应常规用于微创修复漏斗胸。
