Complication Rate of the Nuss Procedure in Adults and Pediatric Patients: A Large Global Healthcare Database Analysis

H. Rshaidat¹, M. Langille. Collins¹, E. Gorgov², S. J. Mack³, G. Whitehorn⁴, L. Meredith⁵, J. Martin², O. Tokunbo. Okusanya^6
1Thomas Jefferson University Hospital, philadelphia, Pennsylvania ²Thomas Jefferson University, Philadelphia, Pennsylvania ³Sidney Kimmel Medical College at Thomas Jeffeson.University, Philadelphia, Pennsylvania ⁴Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania ⁵Thomas Jefferson, Philadelphia, Pennsylvania ⁶Thomas Jefferson University, Haverford, Pennsylvania

Purpose: Pectus excavatum (PE) is characterized by the inward displacement of the sternum and costal cartilages. To date, there is limited data on adult patients undergoing the Nuss procedure for PE. This study aims 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 healthcare database TriNetX. CPT codes (21742, 21743) were used to identify all patients that underwent Nuss procedures in the years 2004- May, 2023. The cohort was then sub-divided based on age and gender. They 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 2,843 patients who underwent Nuss repair were identified within the database. Regardless of age and sex, the most Nuss procedures were performed in the United States in Southern and Midwest states. Most of the patients 2,316 (81%) were < 18, of which 1,826 (86%) were males. Both age groups were comprised predominantly of Caucasians. Patients >18 years old had increased hemorrhagic complications 3% vs 0.86% in patients < 18 years old (p < 0.0001) and acute pain: 55% in patients > 18 years old vs 39.1% in patients < 18 years old, (p < 0.0001). In terms of overall complications, there was no significant difference in total major or minor complications between the two age groups. Overall complication rates were 28.48% in females and 21.7% in males (p=0.0014). Females had higher rates of respiratory complications: 6% vs. 2.7% in males (p=0.0002), chronic pain: 5.2% in females vs. 2% in males (p < 0.0001) and hemorrhagic complications: 6% in females vs. 0.97% in males (p 0.0042).

Conclusion: The majority of Nuss procedures were performed in the Southern and Midwestern US states. This study shows that adults experience significantly increased post operative pain and hemorrhagic complications when compared to the pediatric population. Females experience significantly higher complication rates when compared to males in all age groups.

Identify the source of the funding for this research project: No funding