Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

2021 ◽  
Author(s):  
Centura R. Anbarasu ◽  
Steven C. Mehl ◽  
Raphael C. Sun ◽  
Jorge I. Portuondo ◽  
Andres F. Espinoza ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Pectus Excavatum ◽  
Statistical Significance ◽  
Intercostal Nerve ◽  
Nuss Procedure ◽  
Operative Techniques ◽  
Chi Square ◽  
Patient Demographics ◽  
Haller Index ◽  
Increased Risk

Abstract Introduction The Nuss procedure is the most common and preferred operative correction of pectus excavatum. Surgeon preference and patient factors can result in variations in Nuss procedure technique. We hypothesize that certain techniques are associated with increased risk of complications. Materials and Methods We performed a single-center retrospective review of Nuss operations from 2016 to 2020. Variations in intraoperative techniques included sternal elevator (SE) use, number of bars placed, and usage of bilateral stabilizing sutures. Patient demographics, intraoperative data, and postoperative outcomes were reported as median with interquartile ranges or percentages. Statistical significance (p < 0.05) was determined with Wilcoxon's rank-sum and chi-square tests. Multivariate analysis was performed to control for introduction of intercostal nerve cryoablation and surgeon volume, and reported as odds ratio with 95% confidence interval. Results Two hundred and sixty-five patients were identified. Patients repaired with two bars were older with a larger Haller index (HI). Patient demographics were not significantly different for SE or stabilizing suture use. Placement of two bars was associated with significantly increased risk of readmission. Similarly, SE use was associated with increased risk of pleural effusion and readmission. Finally, the use of bilateral stabilizing sutures resulted in less frequent slipped bars without statistical significance. Conclusion Older patients with a larger HI were more likely to need two bars placed to repair pectus excavatum. Placement of multiple bars and SE use are associated with significantly higher odds of certain complications.

scholarly journals Effects of Pectus Excavatum on the Spine of Pectus Excavatum Patients with Scoliosis

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
WeiHong Zhong ◽  
JinDuo Ye ◽  
JingJing Feng ◽  
LiYang Geng ◽  
GuangPu Lu ◽  
...  
Keyword(s):  
Torsion Angle ◽  
Pectus Excavatum ◽  
Statistical Significance ◽  
Vertical Position ◽  
Haller Index ◽  
Correction Surgery ◽  
Offset Coefficient ◽  
The Right ◽  
Biomechanical Factors ◽  
The Impact

Background. There is high risk in the correction surgery of pectus excavatum with scoliosis because of the lack of the correction mechanism of pectus excavatum with scoliosis. This study performed a comprehensive analysis about the impact that pectus excavatum had on scoliosis and elaborated its biomechanical mechanism in pectus excavatum patients with scoliosis. Methods. 37 pectus excavatum patients were selected. According to age, Haller index of pectus excavatum, offset coefficient, vertical position, sternal torsion angle, and asymmetric index, 37 patients were, respectively, divided into 2 compared groups. The result was statistically calculated. Results. The scoliosis incidence and severity did not correlate with Haller index, offset coefficient, vertical position, sternal torsion angle, and asymmetric index of pectus excavatum, and there was no statistical significance between the two compared groups. Conclusions. The incidence and severity of scoliosis in PE patients with scoliosis have nothing to do with the geometric parameters of pectus excavatum but correlate with age. The scoliosis will aggravate with the increase of age. The heart may provide an asymmetric horizontal force to push the spines to the right. The mechanism of how the biomechanical factors exert influences on spines needs to be further investigated to keep the spine stable.

scholarly journals Intercostal nerve cryoablation versus thoracic epidural for postoperative analgesia following pectus excavatum repair: a systematic review and meta-analysis

2020 ◽  
Vol 31 (4) ◽  
pp. 486-498
Author(s):  
Jean H T Daemen ◽  
Erik R de Loos ◽  
Yvonne L J Vissers ◽  
Maikel J A M Bakens ◽  
Jos G Maessen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Hospital Stay ◽  
Pectus Excavatum ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Intercostal Nerve ◽  
Nuss Procedure ◽  
Thoracic Epidural

Abstract OBJECTIVES Minimally invasive pectus excavatum repair via the Nuss procedure is associated with significant postoperative pain that is considered as the dominant factor affecting the duration of hospitalization. Postoperative pain after the Nuss procedures is commonly controlled by thoracic epidural analgesia. Recently, intercostal nerve cryoablation has been proposed as an alternative method with long-acting pain control and shortened hospitalization. The subsequent objective was to systematically review the outcomes of intercostal nerve cryoablation in comparison to thoracic epidural after the Nuss procedure. METHODS Six scientific databases were searched. Data concerning the length of hospital stay, operative time and postoperative opioid usage were extracted. If possible, data were submitted to meta-analysis using the mean of differences, random-effects model with inverse variance method and I2 test for heterogeneity. RESULTS Four observational and 1 randomized study were included, enrolling a total of 196 patients. Meta-analyses demonstrated a significantly shortened length of hospital stay [mean difference −2.91 days; 95% confidence interval (CI) −3.68 to −2.15; P &lt; 0.001] and increased operative time (mean difference 40.91 min; 95% CI 14.42–67.40; P &lt; 0.001) for cryoablation. Both analyses demonstrated significant heterogeneity (both I2 = 91%; P &lt; 0.001). Qualitative analysis demonstrated the amount of postoperative opioid usage to be significantly lower for cryoablation in 3 out of 4 reporting studies. CONCLUSIONS Intercostal nerve cryoablation during the Nuss procedure may be an attractive alternative to thoracic epidural analgesia, resulting in shortened hospitalization. However, given the low quality and heterogeneity of studies, more randomized controlled trials are needed.

scholarly journals Radiological changes after Nuss operation for pectus excavatum

Medicina ◽  
2009 ◽  
Vol 45 (9) ◽  
pp. 699 ◽  
Author(s):  
Artūras Kilda ◽  
Saulius Lukoševičius ◽  
Vidmantas Barauskas ◽  
Živilė Jankauskaitė ◽  
Algidas Basevičius
Keyword(s):  
Chest Wall ◽  
Pectus Excavatum ◽  
First Year ◽  
Nuss Procedure ◽  
Funnel Chest ◽  
Haller Index ◽  
Wall Deformation ◽  
Lateral Chest ◽  
Radiological Changes ◽  
The Mean

The objective of this study was to evaluate sternovertebral distance and the chest wall deformation after Nuss procedure. Materials and methods. Anteroposterior and lateral chest radiographs were performed before Nuss procedure, 1, 6, and 12 months after operation and finally 1 month after bar removal. Sternovertebral distance and transversal chest dimension were measured on radiographs, as well as Haller and vertebral indexes were calculated. Results. A total of 84 children with funnel chest were operated on. Preoperative sternovertebral distance was 79.81±6.96 mm; 1 month after operation, 97.84±17.08 mm; 6 months, 110.55±13.85 mm; and 12 months, 113.6±14.61 mm. After removal of the bar, the distance was 105±11.95 mm. The mean increase in sternovertebral distance during the first month was 18 mm (P<0.0001); 1–6 months, 12.8 mm (P=0.0006); and 6-12 months, 3 mm (P=0.48). The mean decrease in sternovertebral distance after removal of the bar was 8.6 mm (P=0.47). The decrease in transversal chest dimension during the first month was significant (13.3±12.86 mm, P=0.012). Conclusions. The sternovertebral distance was significantly increased after Nuss operation. Restoration of deformation proceeds during all the first year after operation. The dynamics of deformation is better depicted by means of vertebral index rather than Haller index.

Abstract 15463: Pre-procedural Inr, Bleeding, and Mortality in the Catheterization Lab: Does INR Still Matter in the Radial First Era?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shantum Misra ◽  
Bruce W Andrus ◽  
James T Devries
Keyword(s):  
Hospital Mortality ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Mitigation Strategies ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Access Site ◽  
Chi Square ◽  
Increased Risk ◽  
Chi Square Analysis

Background: Warfarin anticoagulation presents a common barrier to undergoing cardiac catheterization procedures. Using radial access and other bleeding mitigation strategies, it is not known if elevated INR truly portends an increased risk of adverse events. We sought to understand the relationship between in hospital mortality and bleeding with INR in patients undergoing coronary interventional catheterization procedures. Methods: The prospectively-collected Dartmouth Dynamic Registry was queried for all patients who underwent catheterization with coronary intervention from 2014 to 2018. Of the 5015 patients identified, 2120 patients had a recorded INR value within 24 hours of the procedure. Demographics, procedural variables, and in hospital outcomes were collected. Patients were divided into two groups: INR &lt1.8 and INR &gt1.8. Incidence of bleeding (access site hematoma &gt5cm, post procedure blood transfusion) as well as in-hospital mortality were queried for each group. Stata was used to determine statistical significance, using chi-square analysis for categorical variables and standard t-test for continuous variables. Results: Of the 2120 patients with INR values, 1968 patients were identified with INR &lt1.8 (median INR 1.1; range 0.7-1.7) and 152 patients with INR &gt1.8 (median INR 2.2; range 1.8-11.1). Patients with elevated INRs had higher acuity (urgent or emergent cases) and were older. Other baseline and procedural characteristics were similar. Outcomes between those with elevated INR and those with lower INR values were similar, including access site injury, hematoma, and need for transfusion (Table I). Overall mortality did not differ between the two groups. Conclusion: When compared to patients with INR &lt1.8, patients with INR &gt1.8 are more likely to undergo coronary intervention on an urgent or emergent basis. Despite this, there is no difference in bleeding, need for transfusion, or overall in-hospital mortality.

Diagnostic Lobectomy for Bethesda III Thyroid Nodules: Pathological Outcomes and Risk Factors for Malignancy

2021 ◽  
pp. 000348942199397
Author(s):  
Benjamin K. Walters ◽  
Samuel L. Garrett ◽  
James K. Aden ◽  
Grant M. Williams ◽  
Samantha L. Butler-Garcia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Nodules ◽  
Medical Center ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Needle Aspiration ◽  
Chi Square ◽  
Increased Risk ◽  
Risk Of Malignancy ◽  
History Of

Objective: An indeterminate thyroid nodule fine-needle aspiration (FNA) presents a unique dilemma. We evaluated our institution’s experience with Bethesda III thyroid nodules, including the risk of malignancy (ROM) of these nodules removed for diagnostic lobectomy and radiologic and clinical risk factors for malignancy. Study design: Retrospective chart review. Setting: San Antonio Military Medical Center (SAMMC; 483 bed Military Treatment Facility and Level 1 Trauma Center). Methods: We identified all patients with a Bethesda III thyroid FNA at our institution from 2010 to 2018 and determined which nodules were removed. The final histological diagnosis was recorded. Whether or not age, gender, body mass index (BMI), race, nodule size, margin regularity, rate of nodule growth, vascularity, internal calcifications, family history of thyroid cancer, personal history of radiation, and history of repeated AUS/FLUS on FNA had a significant impact on malignancy risk was evaluated with chi square and rank sum Wilcoxon tests. Results: 492 patients had 1 or more AUS result. 52% (258/492) underwent repeat FNA. This resulted in Bethesda II or III in 90% (232/258). In 10% (26/258), the repeat FNA resulted in a higher Bethesda grade. 183 lobectomies were performed on the side containing an AUS nodule. The malignancy percentage was 38.3% (70/183). Age less than 30 was the only variable showing statistical significance for increased risk of malignancy ( P = .04). Conclusion: The ROM of nodules characterized as AUS/FLUS on FNA may be higher than expected. Age may be a better predictor of malignancy than repeat FNA.

scholarly journals Outcomes Following Carpal Tunnel Release in Patients Receiving Workers’ Compensation: A Systematic Review

Hand ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 137-142 ◽  
Author(s):  
John C. Dunn ◽  
Nicholas A. Kusnezov ◽  
Logan R. Koehler ◽  
Dennis Vanden Berge ◽  
Ben Genco ◽  
...  
Keyword(s):  
Systematic Review ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Statistical Significance ◽  
Standard Form ◽  
Outcome Data ◽  
Workers Compensation ◽  
Chi Square ◽  
Patient Demographics

Background: Carpal tunnel syndrome (CTS) is a common occupational pathology, representing a high percentage of workers’ compensation (WC) claims. Methods: The literature was reviewed for all studies evaluating CTS outcomes including WC patients between 1993 and 2016. A total of 348 articles were identified; 25 of which met inclusion and exclusion criteria. A systematic review was generated; patient demographics, outcomes, and complications were recorded. Weighted averages were calculated for the demographic and outcome data. Categorical data such as complications were pooled from the studies and used to determine the overall complication rate. Statistical significance was determined between WC and non-WC cohorts when applicable with the chi-square statistic. Results: The WC cohort included 1586 wrists, and the non-WC cohort included 2781 wrists. The WC cohort was younger and more often involved the dominant extremity. The WC cohort was less likely to have appropriate physical exam findings confirming diagnosis and electrodiagnostic studies. WC patients took almost 5 weeks longer to return to work, were 16% less likely to return to preinjury vocation, and had lower Standard Form (SF)-36 scores. Finally, WC patients had nearly 3 times the number of complications and nearly twice the rate of persistent pain. Conclusions: WC patients undergoing carpal tunnel release (CTR) fare poorly as compared with non-WC patients in nearly every metric. Higher rates of postoperative pain with delayed return to work can be anticipated in a WC cohort. In addition, WC patients receive suboptimal preoperative workup, and it is possible that unnecessary surgery is being completed in these cases. These findings are important to consider when treating the WC patient with CTS.

scholarly journals The hemodynamics during the Nuss procedure for repair of pectus excavatum

2020 ◽  
pp. 7-14
Author(s):  
I.I. Myhal ◽  
Keyword(s):  
Blood Pressure ◽  
General Anesthesia ◽  
Epidural Anaesthesia ◽  
Pectus Excavatum ◽  
Nuss Procedure ◽  
Hemodynamic Parameters ◽  
Regional Analgesia ◽  
Haller Index ◽  
Parents And Children ◽  
Key Words Hemodynamics

Introduction. The hemodynamic parameters during the Nuss procedure for repair of pectus excavatum are under the influence of surgical procedures and anesthetic components especially regional blocks. The aim of the study: analysing the hemodynamic parameters during the Nuss procedure for repair of pectus excavatum under the combination of general anesthesia with different regional analgesia techniques. Materials and methods. The observative prospective study inclueded 60 adolescents (boys/girls=47/13) undergone the Nuss procedure for repair of pectus excavatum under the combination of general anesthesia with different types of regional blocks. The patients were randomized into three groups (n=20 in each) according to the regional analgesia technique: standart epidural anaesthesia in the dermatome of maximal deformity (SEA), high epidural anaesthesia in Th2-Th3 level (HEA) and bilateral paravertebral anaesthesia (PVA). The deformity severity by Haller index in all patients was 3.9 [3.6–4.1]. The blood pressure (BP) and heart rate (HR) were analyzed at different stages of anesthesia and surgery. Results. SEA resulted to significant derease in BP up to 30% compared to initial level before anesthesia. In the HEA group the decrease in BP was moderate and in PVA group the BP did not decrease at all. The sternal elevation and applying capnothorax increased BP without increasing HR. The bar rotation provided a little hemodynamic change in spite of being the most traumatic moment of such surgery. Under PVA HR was moderately increased but BP was almost unchanged, and the intraoperative infusion volume was the smallest in PVA group. HEA provided more stable hemodynamics in comparison to SEA. At the end of surgery hemodynamic parameters almost the same as initial before surgery. Conclusions. During the Nuss procedure for pectus excavatum repair the blood pressure decreased significantly under the standart epidural anaesthesia in the dermatome of maximal deformity, moderately – under the high epidural anaesthesia in Th2-Th3 level and was stable under the bilateral paravertebral anaesthesia. HR decreased under epidural blocks but not under PVA. The sternal elevation and applying capnothorax increased BP. The initial hemodynamic parameters before surgery did not correlate with the severity of deformity according to the Haller index. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent of parents and children was obtained for the study. The author declares no conflict of interest. Key words: hemodynamics, pectus excavatum, Nuss procedure, epidural anaesthesia, paravertebral anaesthesia.

scholarly journals Minimally Invasive Modified Nuss Procedure for Repair of Pectus Excavatum in Pediatric Patients: Single-Centre Retrospective Observational Study

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1071
Author(s):  
Miro Jukić ◽  
Ivan Mustapić ◽  
Tomislav Šušnjar ◽  
Zenon Pogorelić
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Pectus Excavatum ◽  
Pediatric Patients ◽  
Intraoperative Complications ◽  
Late Complications ◽  
Nuss Procedure ◽  
Early Complications ◽  
Female Patients ◽  
Haller Index

Background: The treatment of pectus excavatum can be conservative or surgical. The aim of this study was to determine the factors influencing the outcomes of treatment after a minimally invasive Nuss corrective surgery procedure in pediatric patients. Methods: A total of 30 patient who underwent a minimally invasive Nuss corrective procedure for pectus excavatum from 1 January 2014 to 31 December 2020 were included in thisretrospective study. The collected data included thepatient’s demographic characteristics (age, sex, height, weight, body mass index—BMI, Haller index), treatment outcomes (duration of surgery, length of hospital stay, intraoperative complications, early and late complications, postoperative analgesia), and overall patient and legal guardian satisfaction two years after the procedure. Results: A total of 22 male and 8 female patients were included in the study. The median age was 15 years (interquartile range—IQR 14, 16), and the median BMI was 18.5 kg/m2 (IQR 17.7, 20.4) and 18.2 kg/m2 (IQR 16.9, 18.6) for males and females, respectively. The median CT Haller index was 3.67 (IQR 3.48, 4.09) for male and 3.69 (IQR 3.45, 3.9) for female patients. The median surgery duration was 120 min (IQR 100, 130), and the median hospital stay length was 8.5 days (IQR 8, 9.75). Indications for surgery were psychological (47%), followed by respiratory (30%) and combined respiratory-cardiac (20%) and respiratory-psychological disorders (3%). Early complications were observed in 18 patients (60%), and late complications were observed in 7 patients (23.3%). Intraoperative complications were not recorded. The most common early complications were pneumothorax and subcutaneous emphysema (30%), while late complications included bar displacement (10%) and deformity recurrence (6.6%). Overall,the procedure was successful in 93.1% of patients. Upon arrival home, 22 patients (81.5%) used analgesics for at least one day, up to a maximum of six months. A total of 23 (76.7%) operated patients determined that the surgical procedure had excellent results (grade 5) , 4 (13.3%) patients report a good result (grade 4), 1(3.3%) patient reported a mediocre result, and one patient (3.3%) reported a bad result (grades 3 and 2, respectively). Conclusion: The Nuss procedure is a safe and effective method for treating funnel chest in children and adolescents. It also providesexcellent cosmetic and aesthetic results as well as subjective satisfaction with the outcome of surgical treatment.

scholarly journals Investigation on risk factors of haemorrhagic fever with renal syndrome (HFRS) in Xuancheng City in Anhui Province, Mainland China

2020 ◽  
Vol 148 ◽  
Author(s):  
Guangjian Wu ◽  
Zhicai Xia ◽  
Fengtian Wang ◽  
Jiabing Wu ◽  
Deman Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Statistical Significance ◽  
Mainland China ◽  
Multivariate Logistic Regression Analysis ◽  
Health Concern ◽  
Haemorrhagic Fever ◽  
Chi Square ◽  
Increased Risk ◽  
Chi Square Test

Abstract Haemorrhagic fever with renal syndrome (HFRS), a rodent-borne disease, is a major public health concern in both developed and developing countries. China is the most severe endemic country in the world, constituting 90% of the cases. Although the incidence of HFRS has substantively decreased in most areas of China, HFRS has rebounded remarkably in some epidemic areas. Xuancheng is one of these areas. In this study, we collected the case data reported recently in Xuancheng and designed a 1:3 case−control study. The Chi-square test, univariate and multivariate logistic regression analysis were performed. In all cases, farmers made up the highest proportion of occupations. And there were 20 variables with statistical significance including indoor hygienic conditions; the surrounding environment; whether bitten by rats at work and other criteria. In addition, exposure to rodents and rats bites is a high-risk factor for HFRS. Rodent density was calculated at 20.9% (159/760), the virus carrier rate was 9.4% (15/159) and the index of rats with a virus was about 2.0%. Exposure to rodents and insect bites is also high-risk factors for HFRS among local residents in Xuancheng. More importantly, during the flood years, the increased density of rodents led to an increased risk of human exposure to rodents. As our statistical analysis proves, targeted strategies should be developed and implemented to reduce the incidence of local diseases in the future.

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