微创修复漏斗胸术后正常恢复率的术前决定因素。
Preoperative determinants of normative postoperative recovery rate following minimally invasive repair of pectus excavatum.
机构信息
Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 63, Chicago, IL, 60611, USA.
Shirley Ryan AbilityLab, Chicago, IL, USA.
出版信息
Pediatr Surg Int. 2024 Nov 15;40(1):309. doi: 10.1007/s00383-024-05889-5.
PURPOSE
Recovery after minimally invasive repair of pectus excavatum (MIRPE) is prolonged. The purpose of this prospective study was to enhance our understanding of post-MIRPE recovery by following patients' recovery through postoperative day (POD) 60 using wearable devices and determine if recovery rate is impacted by PE severity and preoperative physical activity (PA) level.
METHODS
Children ≤ 18 years who underwent MIRPE with cryoablation between 8/2023 and 1/2024 wore a Fitbit™ for ≥ 3 days preoperatively to determine preoperative PA and through POD 60. The recovery trajectory, defined by postoperative daily step count divided by mean preoperative daily step count, was fit by power function through POD 60 among patients with uncomplicated recovery. Subgroup analyses were performed to compare recovery by PE severity and preoperative PA level.
RESULTS
Sixteen patients met criteria (68.8% male, mean [SD] age 15.4 [1.6] years). Recovery trajectory analysis demonstrated recovery on POD 60 was 84.8% (95CI 79.0-90.6%). On subgroup analysis, patients with Correction Index > 40% and preoperative mean steps/day ≥ 10,000 had faster recovery.
CONCLUSIONS
Patients undergoing MIRPE with cryotherapy who are more active preoperatively or have higher Correction Indices were found to have accelerated recovery trajectories. These results may provide insight for preoperative counselling and interventions to optimize post-MIRPE recovery.
目的
微创漏斗胸修复术(MIRPE)后的恢复期较长。本前瞻性研究的目的是通过使用可穿戴设备在术后第 60 天跟踪患者的恢复情况,来更好地了解 MIRPE 后的恢复情况,并确定恢复率是否受漏斗胸严重程度和术前体力活动(PA)水平的影响。
方法
2023 年 8 月至 2024 年 1 月期间,接受 MIRPE 联合冷冻消融术治疗的≤18 岁儿童在术前佩戴 Fitbit™ 至少 3 天,以确定术前 PA 水平,并在术后第 60 天内进行测量。通过对恢复轨迹(术后每日步数除以术前平均每日步数)进行幂函数拟合,确定无并发症患者的恢复情况。对不同漏斗胸严重程度和术前 PA 水平的患者进行亚组分析。
结果
共有 16 名患者符合纳入标准(68.8%为男性,平均年龄为 15.4±1.6 岁)。恢复轨迹分析显示,术后第 60 天的恢复率为 84.8%(95%CI 79.0-90.6%)。在亚组分析中,校正指数>40%和术前平均每日步数≥10,000 的患者恢复速度更快。
结论
接受冷冻消融术治疗的 MIRPE 患者,如果术前更活跃或校正指数较高,其恢复轨迹可能会更快。这些结果可能为术前咨询和干预提供参考,以优化 MIRPE 后的恢复。