K. W. Gonzalez1, B. G. Dalton1, E. M. Knott1, B. Kurtz1, A. S. Poola1, C. L. Snyder1, S. D. St. Peter1, G. W. Holcomb1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Pediatric Surgery,Kansas City, MO, USA
Introduction: In July 2011, we established a dedicated center for patients with chest wall deformities to allow for more effective consultation and to initiate a bracing program for the carinatum patients. In this study, we evaluate the effect of this center on patient volume and management.
Methods: A retrospective review was conducted for 699 patients seen with congenital chest, rib and sternal anomalies between July 2009 – June 2013. Patient demographics, operative interventions, clinic and bracing visits were compared, based on the date of initial consultation, before the center opened (July 2009-June 2011, Group 1), versus after (July 2011-June 2013, Group 2). Comparative analysis was performed utilizing chi square and Mann-Whitney U test.
Results: Three hundred twenty new patients were in Group 1 and 379 in Group 2, for an 18.4% increase in patient volume. The number of excavatum patients increased from 172 (Group 1) to 189 (Group 2). The number of carinatum patients increased substantially from 125 (Group 1) to 165 (Group 2). The number of mixed defects and rib/sternal anomalies was similar between groups. The percentage of patients undergoing operative repair of carinatum/mixed defects dropped significantly from 15.1% (Group 1) to 1.1% (Group 2) (p < 0.01) whereas the percentage of patients undergoing nonoperative bracing for carinatum/mixed defects rose significantly from 20.1% (Group 1) to 62.2% (Group 2) (p < 0.01). Patients traveled between 3 and 1249 miles to visit the center for a single visit suggesting that although the majority of patients are regional, the catchment area has extended beyond adjacent states.
Conclusion: Initiating a dedicated pectus center increased patient volume and provided an effective transition to nonoperative bracing for patients with pectus carinatum. The concentrated focus of medical staff dedicated to chest wall deformities has allowed us to treat patients on a local and regional level.