Mack Shale J, Till Brian M, Huang Charles, Thosani Darshak, Rahman Uzma, Grenda Tyler, Evans Nathaniel R, Okusanya Olugbenga T
Sidney Kimmel College of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Thorac Dis. 2022 Apr;14(4):952-961. doi: 10.21037/jtd-21-1671.
There is limited data on the adult repair of pectus excavatum (PE). Existing literature is largely limited to single institution experiences and suggests that adults undergoing modified Nuss repair may have worse outcomes than pediatric and adolescent patients. Using a representative national database, this analysis is the first to describe trends in demographics, outcomes, charges, and facility volume for adults undergoing modified Nuss procedure.
Because of a coding change associated with ICD-10, a retrospective cohort analysis using the National Inpatient Sample (NIS) for patients 12 or older undergoing modified Nuss repair between 2016-2018 was possible. Pearson's χ and Student's -tests were utilized to compare patient, clinical, and hospital characteristics. Complications were sub-classified into major and minor categories. Facilities performing greater than the mean number of operations were categorized as high-volume.
Of 360 patients, 79.2% were male. There was near gender parity for patients over 30 undergoing repair (55.2% male, 44.8% female). In all age cohorts, patients were predominantly Caucasian. Rates of any postoperative complication differed by age (12-17 years: 30.6%; 18-29 years: 45.2%; 30+ years: 62.1%; P<0.01); older patients had higher rates of all but two subclasses of complication. Age over 30 was associated with higher charges (12-17 years: $57,312; 18-29 years: $57,001; 30+ years: $67,014; P<0.01). High-volume centers operate on older patients, had shorter lengths of stay, and comparable charges to low-volume centers.
Women comprise nearly half of patients undergoing modified Nuss repair after 30 years of age. There are significant differences in complication rates and charges when comparing patients by age. Patients undergoing repair at high-volume facilities benefitted from shorter lengths of stay.
关于成人漏斗胸（PE）修复的数据有限。现有文献主要局限于单一机构的经验，表明接受改良努斯修复术的成年人可能比儿童和青少年患者预后更差。本分析利用具有代表性的国家数据库，首次描述了接受改良努斯手术的成年人在人口统计学、预后、费用和机构手术量方面的趋势。
由于与国际疾病分类第10版（ICD - 10）相关的编码变化，对2016 - 2018年间12岁及以上接受改良努斯修复术的患者使用国家住院样本（NIS）进行回顾性队列分析成为可能。采用Pearson卡方检验和学生t检验来比较患者、临床和医院特征。并发症分为主要和次要类别。手术量大于平均手术量的机构被归类为高手术量机构。
在360例患者中，79.2%为男性。30岁以上接受修复术的患者性别接近均等（男性55.2%，女性44.8%）。在所有年龄组中，患者主要为白种人。任何术后并发症的发生率因年龄而异（12 - 17岁：30.6%；18 - 29岁：45.2%；30岁及以上：62.1%；P<0.01）；除两个并发症亚类外，老年患者所有并发症的发生率更高。30岁以上与更高的费用相关（12 - 17岁：57,312美元；18 - 29岁：57,001美元；30岁及以上：67,014美元；P<0.01）。高手术量中心为老年患者做手术，住院时间较短，费用与低手术量中心相当。
30岁以后接受改良努斯修复术的患者中，女性占近一半。按年龄比较患者时，并发症发生率和费用存在显著差异。在高手术量机构接受修复术的患者受益于较短的住院时间。
