Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications

Abstract

Purpose: Because the Nuss procedure for the correction of pectus excavatum is in its early stage, there have been problems that need to be solved. The authors examined complications in a single-institute experience of the Nuss technique to develop possible solutions to prevent them.

Methods: A total of 335 consecutive patients who underwent the Nuss procedure between August 1999 and September 2002 were studied retrospectively. Median age was 8 years (range, 1 to 46). Two hundred sixty-four patients (78.8%) were in the pediatric group (age < or = 15) and 71 patients (21.2%) were in adult group (age > 15). One hundred ninety-three patients (57.6%) had symmetric and 142 patients (42.4%) had asymmetric pectus configurations. Risk factors predicting postoperative complications were analyzed using multivariate logistic regression.

Results: Postoperative complication rate was 16.1% (54 of 335) in total patients. Early complications (within a month) were pneumothorax (n = 23; 6.9%), wound seroma (n = 11; 3.3%), and bar displacement (n = 8; 2.4%). Late complications (after a month) were pericarditis and pericardial effusion (n = 5; 1.5%), bar displacement (n = 4; 1.2%), and hemothorax (n = 3; 0.9%). Techniques were modified to prevent complications especially in bar shaping and fixation, which led to decrease of complication rate in later experience (operation date 1, 29.4%; 15 of 51 v. operation date 2, 12.0%; 34 of 284; P =.004). Grand Canyon type (eccentric long canal type) showed a higher complication rate than other types (40%, 12 of 30 v. 12.1%, 37 of 305; P <.001). Risk factors were analyzed in each group.

Conclusions: Major complications were related to severe eccentric type of pectus configuration (Grand Canyon type) and lack of surgeon's experience (earlier date of operation). Complication rate was reduced with accumulation of experience and advancement of surgical techniques. The Nuss procedure can be performed at a low risk of complications with the current technique.