title: Patient Satisfaction After Minimally Invasive Repair of Pectus Excavatum in Adults: Long-Term Results of Nuss Procedure in Adults.
abstract: BACKGROUND
  Extensive literature has proved that the Nuss procedure leads to permanent remodeling of the chest wall in pediatric patients with pectus excavatum (PE). However, limited long-term follow-up data are available for adults. Herein, we report a single-institution experience in the management of adult PE with the Nuss procedure, evaluating long-term outcomes and overall patient satisfaction after bar removal.
  
  
  METHODS
  Adult patients who underwent PE repair with a modified Nuss procedure between January 1998 and June 2011 were retrospectively identified. Outcomes of interest were postoperative pain, recurrence, and patient satisfaction. A modified single-step Nuss questionnaire was administered to evaluate patient satisfaction and quality-of-life improvement after PE repair.
  
  
  RESULTS
  Ninety-eight patients with a median age of 30.9 years (range, 21.8 to 55.1 years) at the time of repair were identified. One bar was placed in most patients (89.7%). Four patients (4.1%) required reoperation for bar displacement. Results after bar removal were overall satisfactory in 94.4% of patients; 2 patients required reoperation for recurrence. Thirty-nine patients participated in the survey. Satisfaction with chest appearance was reported by 89.7% of responders. Seven patients reported dissatisfaction with the overall results; the most common complaints were severe postoperative chest pain and dissatisfaction with surgical scars.
  
  
  CONCLUSIONS
  Favorable long-term results can be achieved with the Nuss procedure in adults. However, postoperative pain may require a more aggressive analgesic regimen, and it may be the overriding factor in the patient's perception of the quality of the postoperative course.
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Sacco Casamassima
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Colin
authors.initials: C
authors.lastname: Gause
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Goldstein
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Omar
authors.initials: O
authors.lastname: Karim
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Swarup
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kimberly
authors.initials: K
authors.lastname: McIltrot
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Jingyan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, Florida. Electronic address: pc@jhmi.edu.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Colombani
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult