PURPOSE:Minimally invasive repair of pectus excavatum (MIRPE), the elevation of a depressed sternum by means of a curved metal bar, is gaining acceptance as a standard technique. In spite of great success in pediatric patients, older patients have generally been considered a high risk group for this procedure. However, the optimal age for low-risk repair has not been determined. Hence the patients of teenage group linger in a gray zone between the pediatric and adult patients. The purpose of this study was to identify a breaking-point in postoperative complications by age stratification to determine the optimal timing of MIRPE.
METHODS:We retrospectively reviewed data from 1,020 consecutive patients who received MIRPE by a single surgeon from 1999 to 2008. Complications were analyzed and relationships with patient age were examined. The Chow test was used to identify the breaking-point in postoperative complication-age relationships.
RESULTS:The mean patient age was 10.4 years (range 2–51, median 7) and the total complication rate was 13.3% (133/1,020). Major complications, including bar displacement, hemothorax, pericardial effusion, and pneumothorax requiring catheter insertion occurred in 2.8% (29/1,020) of the patients. The Chow test identified the breaking-point at 12 years of age. With this results, the patients were divided into two groups; Group 1 (age<12, n=615) and Group 2 (age =/> 12, n=405), and complication rates were compared: total complication rate, 10.7% vs. 23.1% (p<0.001); bar displacement rate, 1.9% vs. 2.4% (p=0.647); pneumothorax, 2.6% vs. 8.1% (p=0.001); hemothorax, 0% vs. 1.3% (p=0.009), respectively.
CONCLUSION:Patients with pectus excavatum have increased risk of postoperative complications if they receive MIRPE after the age of 12. We believe that the optimal timing for repair is before the age of 12, and that teenagers should be included in the adult group with regard to complications.
CLINICAL IMPLICATIONS:With the current technique, children with pectus excavatum under 12 years can be repaired at a low risk. For patients beyond this limit, proper equipment and repair techniques to minimize complications are necessary.
DISCLOSURE:Hyung Joo Park, No Financial Disclosure Information; No Product/Research Disclosure Information