Factors influencing negative surgical outcomes in adult pectus excavatum patients undergoing Nuss procedure

Zhen Gao; Shujie Huang; Yong Tang; Sichao Wang; Weitao Zhuang; Yu Ding; Hansheng Wu; Jiming Tang; Dongkun Zhang; Haiyu Zhou; Xiaosong Ben; Liang Xie; Gang Chen; Guibin Qiao

doi:10.21037/atm-21-3822

Factors influencing negative surgical outcomes in adult pectus excavatum patients undergoing Nuss procedure

Ann Transl Med. 2021 Aug;9(16):1335. doi: 10.21037/atm-21-3822.

Authors

Zhen Gao^{1

2}, Shujie Huang^{1

3}, Yong Tang¹, Sichao Wang¹, Weitao Zhuang^{1

3}, Yu Ding^{1

2}, Hansheng Wu¹, Jiming Tang¹, Dongkun Zhang¹, Haiyu Zhou¹, Xiaosong Ben¹, Liang Xie¹, Gang Chen¹, Guibin Qiao¹

Affiliations

¹ Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
³ Shantou University Medical College, Shantou, China.

Abstract

Background: This study aimed to examine the factors associated with the negative outcomes of Nuss procedure in adult pectus excavatum (PE) patients.

Methods: Forty-seven adult PE patients were enrolled in this study. Mimics 21.0 software (Materialise) was used to reconstruct the preoperative and postoperative three-dimensional (3D) thoracic model. The preoperative and postoperative pulmonary volumes and function parameters were compared. The diaphragm positions were localized, and the anteroposterior diameter (APD) of the thoracic cavity was calculated using neoteric methods. Binary logistic regression was used to reveal the association between clinical factors and altered pulmonary parameters.

Results: Postoperative lung volumes in adult PE patients decreased significantly (P<0.001). The mean preoperative lung volume was 4,592.82±946.54 cm³, which reduced to 3,976.26±867.35 cm³ postoperatively. The rate of postoperative lung volume reduction was approximately 12.1%. Physiologically, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) significantly decreased after Nuss procedure, and a near 10% reduction in FVC was observed. Diaphragm elevation was positively associated with decrease in lung volumes [odds ratio (OR) =40.51; P=0.011; 95% confidence interval (CI), 2.37-692.59]. The presence of reduced thoracic APDs was significantly associated with negative pulmonary function results (OR =1.21; P=0.008; 95% CI, 1.050-1.388).

Conclusions: This study reveals that thoracic APD reduction and diaphragm elevation are associated with decreased postoperative pulmonary volumes and function in adult PE patients. Nuss procedure for adult patients with PE must be considered cautiously by thoracic surgeons, especially in patients who expect to improve their cardiopulmonary function.

Keywords: Nuss procedure; Pectus excavatum (PE); lung volume measurement; three-dimensional model (3D model).