C. T. Huerta1, W. Ramsey1, D. Alligood1, L. Shagabayeva1, J. Delamater1, M. D. Cobler-Lichter1, A. E. Hernandez1, J. P. Parreco2, E. Perez1, J. E. Sola1, C. M. Thorson1 1University Of Miami, Surgery, Miami, FL, USA 2Memorial Regional Hospital, Surgery, Hollywood, FLORIDA, USA
Introduction: Pectus excavatum (Pectus) is the most prevalent chest wall deformity occurring in approximately 1 in 300 to 400 live births annually. Repair may be offered for those with significant cardiopulmonary compromise or severe cosmetic defects via Nuss or Ravitch repairs. However, few studies have directly compared outcomes after these operations or are limited to single-institution studies. This study aimed to investigate the outcomes of Nuss vs. Ravitch repairs for Pectus utilizing a nationally representative pediatric cohort.
Methods: The Nationwide Readmission Database was queried?from?2016 to 2020?for patients age 12 to 18 years old with Pectus (Q67.6). Demographics, hospital characteristics, and outcomes were analyzed?using standard statistical tests. Results were weighted for national estimates.
Results: A total of 10,415 patients with Pectus underwent repair during the study period, with 90% (n=9,413) treated with Nuss repair and 10% (n=1,002) treated with Ravitch repair. Baseline comorbidities (asthma, psychiatric, scoliosis, valvular disease) were similar between cohorts, although patients treated via Nuss repair more frequently traveled out of state for surgical repair (11% vs. 8% Ravitch) and were in the highest income quartiles (61% vs. 57% Ravitch), both p<0.05. Patients undergoing Ravitch procedures experienced higher rates of postoperative complications, including chest tube placement (1.4% vs. 0.8%), accidental pulmonary injury (1.1% vs. 0.4%), bleeding (3% vs. 0.8%), and air leak (1.1% vs. 0.3%) compared to those treated with Nuss repair, all p<0.005. The Ravitch cohort incurred longer hospital median length of stay (LOS) (4 vs. 3 days Nuss) with more patients having length of stay >7 days (8% vs. 2% Nuss), both p<0.01. Hospitalization costs were higher in those undergoing Ravitch ($18,240 vs. $17,645 Nuss, p<0.001). Both cohorts had similar overall and 30-day readmission rates (Table 1). Patients treated via Ravitch repairs had higher rates of bleeding, pain, and psychiatric complications during readmission.
Conclusion: In this nationwide cohort, pediatric Nuss repairs for Pectus were associated with fewer index complications and cost with no increase in readmissions compared to Ravitch procedures. However, disparities in Nuss utilization exist, with higher-income patients more often traveling out of state for surgical care. This information should be utilized to improve healthcare delivery and defray costs for patients undergoing these procedures.
