Outcomes After Pectus Excavatum Repair: A Nationwide Comparison of Nuss Versus Ravitch Operations

Introduction

Pectus excavatum is the most prevalent chest wall deformity. Repair may be offered via Nuss or Ravitch technique. This study aims to investigate the outcomes of these repairs using a national cohort.

Methods

The Nationwide Readmission Database was queried from 2016 to 2020 for patients aged 12-21 y old with pectus excavatum. Demographics, hospital characteristics, and outcomes were analyzed using standard statistical tests. The results were weighted for national estimates.

Results

A total of 10,053 patients with pectus excavatum underwent repair (86% Nuss, n = 8673 and 14% Ravitch, n = 1380). Baseline characteristics were similar between cohorts. Nuss repair patients traveled more frequently out of state for repair (10.5% versus 8.7%) and were in the highest income quartiles (61.1% versus 57.3%), both P < 0.05. Of reporting hospitals, 60% performed only the Nuss procedure. The Ravitch cohort experienced higher rates of complications during index admission, including chest tube placement (5.1% versus 2.2%), bleeding (2.4% versus 0.6%), air leak (0.9% versus 0.3%), and respiratory failure (1.0% versus 0.3%), as well as longer median length of stay (4 versus 3 d), all with a P value < 0.05. While both cohorts had similar overall readmission rates, Ravitch repairs had higher rates of readmissions for bleeding (18.3% versus 4.5%), pain (32.9% versus 13.5%), and psychiatric complications (31.7% versus 21.2%), all with a P value < 0.05. Ravitch repairs also incurred higher total hospital costs ($18,670 versus 17,462, P < 0.001).

Conclusions

Nuss repairs were associated with fewer index complications with no increase in readmissions compared to Ravitch procedures. However, disparities may exist in access to Nuss repair.