title: Risk factors of infection of implanted device after the Nuss procedure.
abstract: OBJECTIVE
  The Nuss procedure is a minimally invasive procedure for the correction of pectus excavatum. It involves insertion of a substernal metal bar. A feared complication of any implantation procedure is infection, which often requires removal of the implanted device. This report describes the authors' experience with infectious complications after the Nuss procedure.
  
  
  METHODS
  The study included 195 patients diagnosed with pectus excavatum. We performed the Nuss procedure under thoracoscopic control on all the patients. Factors analyzed for all patients included bar infection, sex, age, number of bars, and season of the year during which the operation was performed.
  
  
  RESULTS
  Of the 195 study patients, there were 11 patients who suffered postoperative infectious complications, including 7 patients with cellulitis and 4 patients with bar infections. We removed the infected bars from three of the patients with bar infections. Ten of the patients with infected bar had undergone their operations in the summer. Sex, age and number of bars did not differ significantly between patients with or without infections. However, a significantly higher number of infections occurred among patients who underwent the Nuss procedure in the summer compared with the other seasons of the year (P < 0.05, Kruskal-Wallis Test).
  
  
  CONCLUSIONS
  All patients with cellulitis successfully recovered with conservative treatment. However, 75 % of the patients with bar infections required removal of the infected device. Our study results showed that performance of the Nuss procedure during summer is a risk factor for postoperative infection. We recommend that particularly careful technique must be used during summer to prevent postoperative infections following the Nuss procedure.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan. keiichiro@jikei.ac.jp
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Tanaka
authors.forename: Naruo
authors.initials: N
authors.lastname: Kuwashima
authors.forename: Shu-ichi
authors.initials: S
authors.lastname: Ashizuka
authors.forename: Jyoji
authors.initials: J
authors.lastname: Yoshizawa
authors.forename: Takao
authors.initials: T
authors.lastname: Ohki
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013905:Thoracoplasty / Q000009:adverse effects / Q000379:methods*; D013906:Thoracoscopy; D055815:Young Adult