title: A 20-year review of pectus surgery: an analysis of factors predictive of recurrence and outcomes.
abstract: Only a few studies report the long-term outcomes following repair of pectus excavatum (PE) and pectus carinatum (PC). Predictors of recurrence after surgery are important in this group of young patients. The purpose of this study was to assess the short- and long-term outcomes of both PE and PC and identify factors associated with postoperative complications and pectus recurrence.
  
  
  
  This was a retrospective observational study that included all patients who underwent primary or recurrent repair of PC and PE in a regional thoracic centre over 20 years. Patients' demographics, type of surgery, complications and recurrence were recorded. Logistic regression analysis was performed to identify factors predictive of pectus recurrence.
  
  
  
  A total of 297 patients were included (262 men and 35 women). The mean age was 19.8 years (95% CI 19.3-20.5). A total of 169 patients had surgery for PE and 127 for PC. A total of 243 patients had a modified Ravitch procedure (166 without a bar) and 53 patients underwent the Nuss repair. The main postoperative complications were wound infection and bleeding or haematoma. The recurrence rate over the mean follow-up period of 8.6 years was 10%. In PE, patients treated with the Ravitch procedure with the bar experienced more complications. Univariate and multivariate analyses showed that PE patients who developed a complication had a significantly increased chance of recurrence. No risk factors were linked with recurrence of PC.
  
  
  
  Life-transforming pectus surgery can be performed with low morbidity and good long-term outcomes. Recurrence of PE deformity is associated with the development of postoperative complications.
authors: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
authors: Theofano
authors: T
authors: Tikka
authors: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
authors: Maninder S
authors: MS
authors: Kalkat
authors: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
authors: Ehab
authors: E
authors: Bishay
authors: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
authors: Richard S
authors: RS
authors: Steyn
authors: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
authors: Pala B
authors: PB
authors: Rajesh
authors: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK b.naidu@bham.ac.uk.|Centre for Translational Inflammation Research (CITR), University of Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors: Babu
authors: B
authors: Naidu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D066166:Pectus Carinatum / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Nuss; Pectus; Ravitch; Recurrence; Surgery