Nuss procedure for pectus excavatum repair: critical appraisal of the evidence.
OBJECTIVE
To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.


METHODS
We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).


RESULTS
The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).


CONCLUSIONS
In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.
Getúlio Vargas University Hospital, Federal University of Amazonas, AM, Brazil.
Maria Elizete de Almeida
ME
Araújo
Getúlio Vargas University Hospital, Federal University of Amazonas, AM, Brazil.
Anderson da Paz
Ada P
Penha
Getúlio Vargas University Hospital, Federal University of Amazonas, AM, Brazil.
Fernando Luiz
FL
Westphal
School of Medicine, Federal University of Amazonas.
Marcus Tolentino
MT
Silva
Getúlio Vargas University Hospital, Federal University of Amazonas, AM, Brazil.
Taís Freire
TF
Galvão
D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods; D016896:Treatment Outcome