title: Increasing age at time of pectus excavatum repair in children: emerging consensus?
abstract: BACKGROUND
  Advances in surgical technique for pectus excavatum repair continue to change practice patterns. The present study examines trends in operative age in a nationwide administrative database.
  
  
  METHODS
  A cross-sectional descriptive analysis was performed using the Nationwide Inpatient Sample (NIS) and Kids' Inpatient Database (KID) data from 1998 to 2009. Pediatric discharges involving surgical repair of pectus excavatum were selected. Patients were sub-grouped by age at operation and calendar year of repair for further comparison.
  
  
  RESULTS
  A total of 5830 elective admissions were identified that met inclusion criteria. Mean age at operation was 13.5 years, and this increased from 11.8 years to 14.4 years over the period studied and was accompanied by narrowing of the interquartile range. Examined over groups of four calendar years, patient age at the time of repair was significantly higher in more recent years in both unadjusted and multivariate analyses (P < .001).
  
  
  CONCLUSIONS
  The age at operation in this sample has steadily increased, with an accompanying decrease in variability. This is consistent with previous findings and with overall trends in patient selection reported in the literature. This selection pattern may reflect evolving consensus regarding optimal management of pectus excavatum and provide clinical guidance regarding appropriate referral and intervention.
authors: Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0005, USA.
authors: Dominic
authors: D
authors: Papandria
authors: Jamir
authors: J
authors: Arlikar
authors: Maria Grazia
authors: MG
authors: Sacco Casamassima
authors: Gezzer
authors: G
authors: Ortega
authors: Jose H
authors: JH
authors: Salazar
authors: Yiyi
authors: Y
authors: Zhang
authors: Jeffrey
authors: J
authors: Lukish
authors: Paul
authors: P
authors: Colombani
authors: Fizan
authors: F
authors: Abdullah
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000706:statistics & numerical data / Q000639:trends*; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States