“When to Nuss? patient age as a risk factor for complications of minimally invasive repair of pectus excavatum: a systematic review and meta-analysis”
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Read the article on link.springer.com ↗Article · Mar 2022 · 1 min read
In brief
In brief
Systematic review of 5,978 patients demonstrates that older age significantly increases complication risk for minimally invasive pectus excavatum repair (MIRPE), with patients ≥18 years showing 1.66 times higher odds of complications including pneumothorax, bar displacement, and need for reoperation. Evidence supports performing Nuss procedure before late adolescence to optimize outcomes.
Written by the GCMD Library team from the article.
Abstract
Purpose
The optimal age for minimally invasive repair of pectus excavatum (MIRPE) is unclear; this study investigates the differences in complication rates among different age groups undergoing repair.
Methods
PubMed and Embase databases were searched from inception to October 2020. To assess age as a risk factor for complications, odds ratios from relevant studies were analyzed using the Mantel–Haenszel method with a random-effects model for younger vs older patients. Specific complication rates were compared between the two cohorts using a chi-squared test.
Results
Of the 4448 studies retrieved, 25 studies stratified complication data by age groups. From these studies, ten studies compared groups at ages < 18 and ≥ 18 and four studies compared ages < 20 and ≥ 20, and one study compared ages < 19 and ≥ 19. These fifteen studies reported on 5978 patients, with 1188 complications, for a complication rate of 19.87%. Older patients were more likely to have complications in a pooled analysis of studies comparing older vs younger patients (OR = 1.66, 95% CI = 1.28–2.14, heterogeneity I2 = 49%). Specifically, older patients were significantly more likely to experience pneumothorax, pleural effusion, wound infection, bar displacement, and reoperations.
Conclusion
Increased age is a risk factor for complications of MIRPE. This supports repair of pectus excavatum prior to late adolescence.