Rshaidat Hamza, Gorgov Eliyahu, Collins Micaela L, Mack Shale J, Whitehorn Gregory L, Martin Jonathan, Meredith Luke, Nevler Avinoam, Okusanya Olugbenga T
Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Philadelphia.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Ann Thorac Surg Short Rep. 2024 Apr 27;2(3):364-368. doi: 10.1016/j.atssr.2024.04.013. eCollection 2024 Sep.
Pectus excavatum (PE) is the most common congenital chest wall defect and is characterized by the inward displacement of the sternum and costal cartilages. To date, there are limited data on adult patients undergoing the Nuss procedure for PE. This study aimed to assess the complication rate between the pediatric and adult populations and assess the trends in demographics.
Retrospective analysis was conducted using a global health care database, TriNetX. Current Procedural Terminology codes (21742, 21743) were used to identify all patients who underwent Nuss procedures in the years 2004 to 2023. The cohort was then subdivided on the basis of age and sex. These patients were assessed for 30-day and 90-day major and minor postoperative complications, as well as acute pain and chronic postoperative pain.
A total of 2843 patients who underwent Nuss repair were identified. Patients aged >18 years had increased hemorrhagic complications (3% vs 0.86% in patients aged <18 years; < .001) and acute pain (55% in patients aged >18 years vs 39.1% in patients aged <18 years; < .001). Overall complication rates were 28.48% in female patients and 21.7% in male patients ( = .0014). Female patients had higher rates of respiratory complications (6% vs 2.7% in male patients; = .001), chronic pain (5.2% in female patients vs 2% in male patients; < .001), and hemorrhagic complications (6% in female patients vs 0.97% in male patients; = .0042).
This study suggests that adults with PE experience significantly increased postoperative pain and hemorrhagic complications after the Nuss procedure when compared with the pediatric population. Female patients experience significantly higher complication rates when compared with male patients in all age groups.
漏斗胸（PE）是最常见的先天性胸壁畸形，其特征是胸骨和肋软骨向内移位。迄今为止，关于成年漏斗胸患者接受努氏手术的数据有限。本研究旨在评估儿童和成年人群的并发症发生率，并分析人口统计学趋势。
使用全球医疗保健数据库TriNetX进行回顾性分析。采用当前手术操作术语代码（21742、21743）识别2004年至2023年期间所有接受努氏手术的患者。然后根据年龄和性别对队列进行细分。评估这些患者术后30天和90天的主要和次要并发症，以及急性疼痛和慢性术后疼痛。
共识别出2843例接受努氏修复手术的患者。年龄大于18岁的患者出血性并发症增加（3%，而年龄小于18岁的患者为0.86%；P<0.001），急性疼痛发生率更高（年龄大于18岁的患者为55%，年龄小于18岁的患者为39.1%；P<0.001）。女性患者的总体并发症发生率为28.48%，男性患者为21.7%（P = 0.0014）。女性患者的呼吸系统并发症发生率更高（6%，男性患者为为2.7%；P = 0.001），慢性疼痛发生率更高（女性患者为5.2%，男性患者为2%；P<0.001），出血性并发症发生率更高（女性患者为6%，男性患者为0.97%；P = 0.0042）。
本研究表明，与儿童人群相比，成年漏斗胸患者在接受努氏手术后术后疼痛和出血性并发症显著增加。在所有年龄组中，女性患者的并发症发生率显著高于男性患者。
