Multicenter study of pectus excavatum, final report: complications, static/exercise pulmonary function, and anatomic outcomes.
BACKGROUND
A multicenter study of pectus excavatum was described previously. This report presents our final results.


METHODS
Patients treated surgically at 11 centers were followed prospectively. Each underwent a preoperative evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, complications, and perioperative pain. One year after treatment, patients underwent repeat chest CT scan, pulmonary function tests, and body image survey. A subset of 50 underwent exercise pulmonary function testing.


RESULTS
Of 327 patients, 284 underwent Nuss procedure and 43 underwent open procedure without mortality. Of 182 patients with complete follow-up (56%), 18% had late complications, similarly distributed, including substernal bar displacement in 7% and wound infection in 2%. Mean initial CT scan index of 4.4 improved to 3.0 post operation (severe >3.2, normal = 2.5). Computed tomography index improved at the deepest point (xiphoid) and also upper and middle sternum. Pulmonary function tests improved (forced vital capacity from 88% to 93%, forced expiratory volume in 1 second from 87% to 90%, and total lung capacity from 94% to 100% of predicted (p < 0.001 for each). VO2 max during peak exercise increased by 10.1% (p = 0.015) and O2 pulse by 19% (p = 0.007) in 20 subjects who completed both pre- and postoperative exercise tests.


CONCLUSIONS
There is significant improvement in lung function at rest and in VO2 max and O2 pulse after surgical correction of pectus excavatum, with CT index >3.2. Operative correction significantly reduces CT index and markedly improves the shape of the entire chest, and can be performed safely in a variety of centers.
Department of Surgery, Children's Hospital of The King's Daughters, Norfolk, VA; Department of Surgery, Eastern Virginia Medical School, Norfolk, VA. Electronic address: Robert.Kelly@chkd.org.
Robert E
RE
Kelly
Robert B
RB
Mellins
Robert C
RC
Shamberger
Karen K
KK
Mitchell
M Louise
ML
Lawson
Keith T
KT
Oldham
Richard G
RG
Azizkhan
Andre V
AV
Hebra
Donald
D
Nuss
Michael J
MJ
Goretsky
Ronald J
RJ
Sharp
George W
GW
Holcomb
Walton K T
WK
Shim
Stephen M
SM
Megison
R Lawrence
RL
Moss
Annie H
AH
Fecteau
Paul M
PM
Colombani
Dan
D
Cooper
Traci
T
Bagley
Amy
A
Quinn
Alan B
AB
Moskowitz
James F
JF
Paulson
D000293:Adolescent; D001828:Body Image; D002648:Child; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011581:Psychological Tests; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
CO(2) production; FEV(1); FVC; HR; O(2) consumption; V(CO(2)); V(O(2)); VE; WR; forced expiratory volume in 1 second; forced vital capacity; heart rate; ventilation; work rate