Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Shawn D St. Peter, MD
Start Date
12-5-2021 11:30 AM
End Date
12-5-2021 1:30 PM
Presentation Type
Poster Presentation
Description
Background: Some patients with pectus excavatum require bar removal despite having the bar in for less than three years after minimally invasive placement (MIRPE). It is unknown whether early removal is associated with a higher recurrence rate or lower cosmetic satisfaction.
Objectives/Goal: The aim of this study was to review post-operative outcomes, specifically recurrence rate, and patient satisfaction in patients who underwent bar removal prior to three years.
Methods/Design: A retrospective review was performed of patients who underwent MIRPE between October 2006 and June 2017 and had bar removal less than 3 years after repair. Demographics, reason for bar removal, recurrence rate, and post-operative complications were captured. Telephone follow-up of patients was performed to evaluate for long-term recurrence and patient’s satisfaction with their chest appearance.
Results: Forty-four patients underwent bar removal at a median of 2.1 years (IQR 1.99, 2.38). The median age at bar placement was 13.3 years old (IQR 11.5, 15.6), with a Haller Index of 4.0 (IQR 3.5, 4.5). The most common reasons for bar removal included over-correction or new pectus carinatum deformity (n=7, 16%) and moving away from home (n=5, 11%). Seventeen patients (39%) had no reason recorded. Post-operatively, two patients had a recurrence. One required bracing, and one developed a bar infection requiring removal and subsequently underwent an osteotomy for combined pectus excavatum/ carinatum deformity. Another patient subsequently underwent bracing for pectus carinatum. Four patients underwent additional surgery for costal cartilage resection (n=3) or scar revision (n=1). Seventeen of 34 patients (50%) with existing phone numbers in our hospital records were able to be contacted. Median time between bar removal and follow-up was 9.0 years (range: 0.64-11.0 years); 9 patients (53%) were contacted > 9 years following bar removal. Nine patients felt they had some recurrence; however, only 2 stated this deformity was > 25% in depth. One patient felt the deformity was severe enough to seek re-evaluation, with bracing and exercises recommended. Overall, 7 patients (41%) were “very satisfied” with their chest appearance, including 3 who noted a residual deformity. Ten (59%) were “somewhat satisfied” with their chest appearance: five noted that part of their chest still slightly protrudes, and three stated that the deformity was not severe enough to warrant any intervention. No patient was “not satisfied” with their appearance.
Conclusions: Bar removal prior to 3 years in patients with symptoms does not increase need for redo correction and maintains good patient cosmetic satisfaction. This data also suggests that garnering more long-term follow-up information is warranted.
MeSH Keywords
pectus excavatum; minimally invasive surgery; recurrence; patient satisfaction; bar removal
Additional Files
Bar Removal Following Minimally Invasive Pectus Excavatum Repair.pdf (194 kB)Abstract
Bar Removal Following Minimally Invasive Pectus Excavatum Repair – Does Removal at 2 Years Affect Recurrence or Satisfaction Rates?
Background: Some patients with pectus excavatum require bar removal despite having the bar in for less than three years after minimally invasive placement (MIRPE). It is unknown whether early removal is associated with a higher recurrence rate or lower cosmetic satisfaction.
Objectives/Goal: The aim of this study was to review post-operative outcomes, specifically recurrence rate, and patient satisfaction in patients who underwent bar removal prior to three years.
Methods/Design: A retrospective review was performed of patients who underwent MIRPE between October 2006 and June 2017 and had bar removal less than 3 years after repair. Demographics, reason for bar removal, recurrence rate, and post-operative complications were captured. Telephone follow-up of patients was performed to evaluate for long-term recurrence and patient’s satisfaction with their chest appearance.
Results: Forty-four patients underwent bar removal at a median of 2.1 years (IQR 1.99, 2.38). The median age at bar placement was 13.3 years old (IQR 11.5, 15.6), with a Haller Index of 4.0 (IQR 3.5, 4.5). The most common reasons for bar removal included over-correction or new pectus carinatum deformity (n=7, 16%) and moving away from home (n=5, 11%). Seventeen patients (39%) had no reason recorded. Post-operatively, two patients had a recurrence. One required bracing, and one developed a bar infection requiring removal and subsequently underwent an osteotomy for combined pectus excavatum/ carinatum deformity. Another patient subsequently underwent bracing for pectus carinatum. Four patients underwent additional surgery for costal cartilage resection (n=3) or scar revision (n=1). Seventeen of 34 patients (50%) with existing phone numbers in our hospital records were able to be contacted. Median time between bar removal and follow-up was 9.0 years (range: 0.64-11.0 years); 9 patients (53%) were contacted > 9 years following bar removal. Nine patients felt they had some recurrence; however, only 2 stated this deformity was > 25% in depth. One patient felt the deformity was severe enough to seek re-evaluation, with bracing and exercises recommended. Overall, 7 patients (41%) were “very satisfied” with their chest appearance, including 3 who noted a residual deformity. Ten (59%) were “somewhat satisfied” with their chest appearance: five noted that part of their chest still slightly protrudes, and three stated that the deformity was not severe enough to warrant any intervention. No patient was “not satisfied” with their appearance.
Conclusions: Bar removal prior to 3 years in patients with symptoms does not increase need for redo correction and maintains good patient cosmetic satisfaction. This data also suggests that garnering more long-term follow-up information is warranted.
