title: Complications related to the Nuss procedure: minimizing risk with operative technique.
abstract: BACKGROUND
  Pectus Excavatum (PEx) is the most frequent congenital chest wall deformity; surgical correction has a complication rate of 10%-50%. The purpose of this study was to evaluate outcomes in a recent cohort of pediatric patients from a single institution and investigate factors associated with complications.
  
  
  METHODS
  A review of all patients with PEx treated with a Nuss procedure from 2003 to 2011 was performed. Complications included hemo/pneumothorax, infection, bar migration, and operative injury. Chi-square, Student's t-test, and logistic regression were performed.
  
  
  RESULTS
  The study included 127 Nuss patients with a the median age of 15.2 years (5.4-18.7) and a mean Haller index of 4.2 (+1.6). The total complication rate was 26% and bar migration rate was 18%. The use of a stabilizer was associated with fewer overall complications (17% vs 41%,p=0.006), decreased reoperation (16% vs 41%,p=0.003), decreased readmission (15% vs 39%,p=0.004), and decreased bar migration rate (9% vs 36%,p=0.001) compared to patients without a stabilizer. On multivariate analysis, the use of a stabilizer (OR 0.18,p=0.011,95% CI 0.049-0.68) and the use of a pericostal suture (OR 0.19,p=0.03,95% CI 0.41-0.85) were associated with decreased rates of bar migration.
  
  
  CONCLUSIONS
  The use of a lateral stabilizer and pericostal sutures decreased complication and reoperation rates for the Nuss procedure.
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Slater
authors.forename: Jed G
authors.initials: JG
authors.lastname: Nuchtern
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.forename: Eugene S
authors.initials: ES
authors.lastname: Kim
authors.forename: Monica E
authors.initials: ME
authors.lastname: Lopez
authors.forename: Mark V
authors.initials: MV
authors.lastname: Mazziotti
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology; D005660:Funnel Chest / Q000601:surgery*; D006491:Hemothorax / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009984:Orthopedic Fixation Devices / Q000009:adverse effects; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D019919:Prosthesis Implantation / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D013536:Suture Techniques