title: Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications.
abstract: OBJECTIVE
  Because the Nuss procedure for the correction of pectus excavatum is in its early stage, there have been problems that need to be solved. The authors examined complications in a single-institute experience of the Nuss technique to develop possible solutions to prevent them.
  
  
  METHODS
  A total of 335 consecutive patients who underwent the Nuss procedure between August 1999 and September 2002 were studied retrospectively. Median age was 8 years (range, 1 to 46). Two hundred sixty-four patients (78.8%) were in the pediatric group (age < or = 15) and 71 patients (21.2%) were in adult group (age > 15). One hundred ninety-three patients (57.6%) had symmetric and 142 patients (42.4%) had asymmetric pectus configurations. Risk factors predicting postoperative complications were analyzed using multivariate logistic regression.
  
  
  RESULTS
  Postoperative complication rate was 16.1% (54 of 335) in total patients. Early complications (within a month) were pneumothorax (n = 23; 6.9%), wound seroma (n = 11; 3.3%), and bar displacement (n = 8; 2.4%). Late complications (after a month) were pericarditis and pericardial effusion (n = 5; 1.5%), bar displacement (n = 4; 1.2%), and hemothorax (n = 3; 0.9%). Techniques were modified to prevent complications especially in bar shaping and fixation, which led to decrease of complication rate in later experience (operation date 1, 29.4%; 15 of 51 v. operation date 2, 12.0%; 34 of 284; P =.004). Grand Canyon type (eccentric long canal type) showed a higher complication rate than other types (40%, 12 of 30 v. 12.1%, 37 of 305; P <.001). Risk factors were analyzed in each group.
  
  
  CONCLUSIONS
  Major complications were related to severe eccentric type of pectus configuration (Grand Canyon type) and lack of surgeon's experience (earlier date of operation). Complication rate was reduced with accumulation of experience and advancement of surgical techniques. The Nuss procedure can be performed at a low risk of complications with the current technique.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Chunan Hospital, Chunan, South Korea.
authors.forename: Hyung Joo
authors.initials: HJ
authors.lastname: Park
authors.forename: Seock Yeol
authors.initials: SY
authors.lastname: Lee
authors.forename: Cheol Sae
authors.initials: CS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005660:Funnel Chest / Q000601:surgery*; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007223:Infant; D010490:Pericardial Effusion / Q000209:etiology; D010493:Pericarditis / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000209:etiology; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*