Complication Rate of the Nuss Procedure in Adults and Pediatric Patients: National Database Analysis

Background

Pectus excavatum (PE) is the most common congenital chest wall defect and is characterized by the inward displacement of the sternum and costal cartilages. To date, there are limited data on adult patients undergoing the Nuss procedure for PE. This study aimed to assess the complication rate between the pediatric and adult populations and assess the trends in demographics.

Methods

Retrospective analysis was conducted using a global health care database, TriNetX. Current Procedural Terminology codes (21742, 21743) were used to identify all patients who underwent Nuss procedures in the years 2004 to 2023. The cohort was then subdivided on the basis of age and sex. These patients were assessed for 30-day and 90-day major and minor postoperative complications, as well as acute pain and chronic postoperative pain.

Results

A total of 2843 patients who underwent Nuss repair were identified. Patients aged >18 years had increased hemorrhagic complications (3% vs 0.86% in patients aged <18 years; P < .001) and acute pain (55% in patients aged >18 years vs 39.1% in patients aged <18 years; P < .001). Overall complication rates were 28.48% in female patients and 21.7% in male patients (P = .0014). Female patients had higher rates of respiratory complications (6% vs 2.7% in male patients; P = .001), chronic pain (5.2% in female patients vs 2% in male patients; P < .001), and hemorrhagic complications (6% in female patients vs 0.97% in male patients; P = .0042).

Conclusions

This study suggests that adults with PE experience significantly increased postoperative pain and hemorrhagic complications after the Nuss procedure when compared with the pediatric population. Female patients experience significantly higher complication rates when compared with male patients in all age groups.