title: When patients choose: comparison of Nuss, Ravitch, and Leonard procedures for primary repair of pectus excavatum.
abstract: OBJECTIVE
  Pectus excavatum is a common chest wall deformity, and several procedures have been developed for its correction. We allow patients to choose among Leonard, Nuss, and Ravitch procedures. This study aimed to determine which procedure most patients select and the resultant outcomes.
  
  
  METHODS
  Charts were reviewed of all pectus excavatum repairs performed for 4 years by a practice covering a university-based children's hospital. Procedure choice, operative time, length of stay, analgesia, fees, and complications were recorded.
  
  
  RESULTS
  The Ravitch procedure was chosen by 60.9% of our patients, Leonard procedure by 23.9%, and Nuss procedure by 15.2%. Operative times were not significantly different among the groups. The mean length of stay was 2.2 days (Ravitch), 1.5 days (Leonard), and 3.9 days (Nuss) (P < .005). Epidural analgesia/patient-controlled analgesia pump requirements were 50% (Ravitch), 5% (Leonard), and 100% (Nuss). The mean charges were $27,414 (Ravitch), $18,094 (Leonard), and $43,749 (Nuss) (P < .05). The overall complication rate was 16.3%. The complications among each group were as follows: Ravitch, 14.3%; Leonard, 9.1%; and Nuss, 35.7%.
  
  
  CONCLUSIONS
  We allow patients to choose among Leonard, Ravitch, and Nuss procedures for repair of pectus excavatum. Most select the Ravitch procedure. Length of stay, fees, analgesic needs, and complication rate were highest among patients in the Nuss group; all of these variables were lowest in the Leonard group.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University of Minnesota, Minneapolis, MN 55455, USA. rose0437@umn.edu
authors.forename: Mara B
authors.initials: MB
authors.lastname: Antonoff
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Erickson
authors.forename: Donavon J
authors.initials: DJ
authors.lastname: Hess
authors.forename: Robert D
authors.initials: RD
authors.lastname: Acton
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Saltzman
mesh_terms: D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D055815:Young Adult