Weight Gain After Vertical Expandable Prosthetic Titanium Rib Surgery May Be From Nutritional Optimization Rather Than Improvement in Pulmonary Function.
METHODS
Prospective comparative study.


OBJECTIVE
To evaluate whether weight percentile (WP) increases after vertical expandable prosthetic titanium rib (VEPTR) insertion, and whether WP correlates with nutrition laboratories and pulmonary function.


BACKGROUND
Children with thoracic insufficiency syndrome often have "failure to thrive" (WP ≤5). Previous authors have reported an increase in WP after VEPTR surgery. Weight gain was hypothesized to be secondary to improved pulmonary function. The presence of a correlation between WP and nutrition laboratories and pulmonary function tests (PFT) after VEPTR insertion has not been studied.


METHODS
Demographic, nutrition, radiographic, and PFT data were collected on 35 VEPTR patients with a minimum follow-up of 2 years. The relationship between WP and nutrition laboratories and pulmonary function was analyzed.


RESULTS
Preoperative WP was ≤5 (PREOP≤5) in 13 patients (37%) and >5 (PREOP>5) in 22 patients (63%). Although all children gained weight, the PREOP≤5 group was more likely to have an increase in WP (P = 0.014). Sixty-eight percent of the PREOP>5 group had a decrease in WP and 32% of the PREOP>5 patients met the criteria for failure to thrive at final follow-up. Overall, there was no change in the number of children with a WP ≤5 (13 vs. 15). Forty-two percent of the children who maintained or increased their WP had a gastrostomy tube, compared to 19% of those who decreased their WP. Seventy-three percent of the patients with failure to thrive at final follow-up did not have a gastrostomy tube. No significant correlations were found between WP and nutrition laboratories, radiographic measures, or PFTs.


CONCLUSIONS
We did not find an overall change in WP after VEPTR insertion. We did not find any correlation between WP and nutrition laboratories or pulmonary function. Weight gain after VEPTR surgery may be secondary to nutritional optimization in high-risk patients. Children who do not have failure to thrive at presentation also require attention.


METHODS
2.
Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Ying
Y
Li
Maksim A
MA
Shlykov
Christopher B
CB
Robbins
Frances A
FA
Farley
Michelle S
MS
Caird
Michelle C
MC
Burke
D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D005183:Failure to Thrive / Q000503:physiopathology*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D008297:Male; D009752:Nutritional Status; D011446:Prospective Studies; D019736:Prostheses and Implants; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000601:surgery*; D012272:Ribs / Q000601:surgery*; D013577:Syndrome; D014025:Titanium; D016896:Treatment Outcome; D015430:Weight Gain
D014025:Titanium