title: Minimally Invasive Repairs of Pectus Excavatum: Surgical Outcomes, Quality of Life, and Predictors of Reoperation.
abstract: BACKGROUND
  We sought to examine our institutional experience (1998 to 2014) with minimally invasive repairs of pectus excavatum (MIRPE).
  
  
  METHODS
  We conducted a retrospective review and a mailed survey (quality of life assessment). Associations with reoperation due to bar migration and recurrence after bar removal were evaluated with logistic regression.
  
  
  RESULTS
  Three hundred and thirteen patients (79% male) underwent MIRPE at a mean ± SD age of 15 ± 3 years. Bar migration requiring reoperation occurred in 16 (5%) patients (median 26 days, interquartile range 15 to 70 days from repair). Wire fixation (hazard ratio [HR] = 3.16; p = 0.014) and bar stabilizer (HR = 4.57; p = 0.002) use were associated with increased risk of reoperation, and bilateral pericostal suture fixation (HR = 0.15; p < 0.001) and thoracoscopic assistance (78%, HR = 0.23; p < 0.001) were associated with decreased risks. Reoperations rates varied (6% to 26%) during the first 50 cases of each surgeon (n = 6), falling to ≤2% afterward. Of the 101 (32%) patients who have had their bars removed electively, 10 (10%) have required reoperation for recurrence. Patients with a recurrence after bar removal were younger (14.1 ± 3.9 years vs 18.4 ± 3.7 years; p = 0.007) and had their bars removed earlier (2.4 ± 1.2 years vs 3.8 ± 2.1 years; p = 0.036). Of survey respondents (n = 145 [47%]), most (99%) were either very happy (n = 79) or mostly happy (n = 63) with their outcomes.
  
  
  CONCLUSIONS
  Although excellent outcomes after MIRPE can be achieved, our results highlight identified strategies that are associated with decreased risk of reoperation (eg, use of bilateral pericostal suture fixation, surgeon experience, and thoracoscopic guidance). Our results also suggest that elective bar removal should be delayed until the patient is at least 18 years old and has had the bar in for at least 4 years.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Waleed
authors.initials: W
authors.lastname: Gibreel
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zendejas
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Daniel
authors.initials: D
authors.lastname: Joyce
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: moir.christopher@mayo.edu.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Moir
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
mesh_terms: D000293:Adolescent; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome