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National Trends in Pectus Excavatum Repair
Shale J. Mack, Brian M. Till, Charles Huang, Uzma Rahman, Darshak Thosani, Tyler Grenda, Nathaniel R. Evans, III, Olugbenga T. Okusanya.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.

BACKGROUND Pectus excavatum (PE) is the most common congenital chest wall deformity. The standard of care for severe or symptomatic PE is surgical repair with the favored approach being the Nuss repair. Previous reports on Nuss repairs have predominantly been single-institution retrospective studies and in the pediatric population. We aim to describe trends in the utilization and outcomes of Nuss repairs for adolescent and adult patients using a well sourced national database.
METHODS A retrospective cohort analysis was completed with the National Inpatient Sample for patients 12 years or older who underwent a Nuss repair from 2016-2018. Pearson′s X2 and Studentís t tests were utilized to compare patient, clinical and hospital characteristics. For comparison, complications were sub-classified into major and minor. Hospitals performing greater than the mean number of operations per facility were categorized as high-volume.
RESULTS A total of 373 patients were included in our cohort over the three year period. The majority of patients were male (79.1%). Increasing patient age was associated with higher complication rate, greater cost and more female patients. Most Nuss repairs were performed at low-volume hospitals (70.2%). High-volume centers appeared to operate on older patients, have a shorter length of stay and have comparable costs to low-volume centers. Though the overall rate of complication was greater at high-volume centers, major complications occurred at similar rates.
CONCLUSIONS There are significant national differences in outcomes for the Nuss repair specifically based on the age of the patient and the volume of the center.


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