Changes in resting pulmonary function testing over time after the Nuss procedure: A systematic review and meta-analysis
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In brief
In brief
Systematic review of 465 patients shows pulmonary function initially declines after Nuss procedure for pectus excavatum, with FEV1 showing modest improvement at 2+ years post-surgery. Meta-regression reveals temporal relationship between surgery timing and lung function recovery, though return to normal function remains uncertain.
Written by the GCMD Library team from the article.
Background
Pectus excavatum, the most common congenital chest wall deformity in pediatric patients, leads to pulmonary dysfunction. There is no consensus regarding the effectiveness of the Nuss procedure for recovering pulmonary function. In this meta- analysis, we focused on the changes that occur in pulmonary function after the Nuss procedure.
Methods
We performed a literature search in the MEDLINE, Embase, Cochrane library and PubMed databases. The included studies were required to contain pulmonary function tests with results adjusted to predicted values both before and after the Nuss procedure. The key outcomes of interest in this analysis were pulmonary function measured as forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC). Subgroup analyses were performed based on time since surgery and the mean ages of the patients when they underwent surgery by forest plots and meta-regressions.
Results
Thirteen studies involving 465 participants were included in this review. The standard mean difference (SMD) observed in FEV1 and FVC after surgery were 0.17 (95% CI, 0.01–0.33, p=0.04) and −0.18 (95% CI, −0.41–0.06, p=0.14), respectively. The overall meta-regression SMD of FEV1 and FVC by time since surgery were 1.21 (95% CI, 1.04–1.41, p=0.020) and 1.38 (95% CI, 1.05–1.83, p=0.027), respectively. We found evidence of a temporal relationship between time at which pulmonary function tests were performed after surgery and predicted FEV1 and FVC values. The SMD of FEV1 (0.26, p=0.012) was slightly higher in group evaluated more than 2year after initial surgery.
Conclusions
Abnormal resting pulmonary functions tests performed prior to surgery showed an initial depression after surgery. The FEV1 of patients slightly increased at 2year post surgery compared with the baseline. Further studies with longer term follow-up are still needed to determine if pulmonary function could improve to normal after surgery.
Levels of Evidence
Level of evidence: 4 (based on lowest level of article analyzed in meta-analysis/systematic review).