Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study.
OBJECTIVE
This study evaluated changes in both physical and psychosocial quality of life reported by the parent and child after surgical repair of pectus excavatum.


METHODS
As part of a multicenter study of pectus excavatum, a previously validated tool called the Pectus Excavatum Evaluation Questionnaire was administered by the research coordinator, via telephone, to parents and patients (8-21 years of age) before and 1 year after surgery. Eleven North American children's hospitals participated. From 2001 to 2006, 264 patients and 291 parents completed the initial questionnaire, and 247 patients and 274 parents completed the postoperative questionnaire. Responses used a Likert-type scale of 1 to 4, reflecting the extent or frequency of a particular experience, with higher values conveying less-desirable experience.


RESULTS
Preoperative psychosocial functioning was unrelated to objective pectus excavatum severity (computed tomographic index). Patients and their parents reported significant positive postoperative changes. Improvements occurred in both physical and psychosocial functioning, including less social self-consciousness and a more-favorable body image. For children, the body image component improved from 2.30+/-0.62 (mean+/-SD) to 1.40+/-0.42 after surgery and the physical difficulties component improved from 2.11+/-0.82 to 1.37+/-0.44. For the parent questionnaire, the child's emotional difficulties improved from 1.81+/-0.70 to 1.24+/-0.36, social self-consciousness improved from 2.86+/-1.03 to 1.33+/-0.68, and physical difficulties improved from 2.14+/-0.75 to 1.32+/-0.39. Ninety-seven percent of patients thought that surgery improved how their chest looked.


CONCLUSIONS
Surgical repair of pectus excavatum can significantly improve the body image difficulties and limitations on physical activity experienced by patients. These results should prompt physicians to consider the physiologic and psychological implications of pectus excavatum just as they would any other physical deformity known to have such consequences.
Kelly
Robert E
RE
Department of Surgery, Eastern Virginia Medical School, 601 Children's Lane, Suite 5B, Norfolk, VA 23507, USA. robert.kelly@chkd.org
Cash
Thomas F
TF
Shamberger
Robert C
RC
Mitchell
Karen K
KK
Mellins
Robert B
RB
Lawson
M Louise
ML
Oldham
Keith
K
Azizkhan
Richard G
RG
Hebra
Andre V
AV
Nuss
Donald
D
Goretsky
Michael J
MJ
Sharp
Ronald J
RJ
Holcomb
George W
GW
Shim
Walton K T
WK
Megison
Stephen M
SM
Moss
R Lawrence
RL
Fecteau
Annie H
AH
Colombani
Paul M
PM
Bagley
Traci
T
Quinn
Amy
A
Moskowitz
Alan B
AB
D000293:Adolescent; D000367:Age Factors; D001828:Body Image; D002648:Child; D002675:Child, Preschool; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D017060:Patient Satisfaction; D011336:Probability; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult