“When to Nuss? patient age as a risk factor for complications of minimally invasive repair of pectus excavatum: a systematic review and meta-analysis”

Infographic · May 2022 · 1 min read

In brief

This systematic review of nearly 6,000 patients demonstrates that older age significantly increases complication risk following minimally invasive pectus excavatum repair, with patients ≥18 years experiencing 66% higher odds of complications including pneumothorax, bar displacement, and reoperation. The findings support performing MIRPE before late adolescence to optimize outcomes.

Older patients (≥18 years) have 1.66 times higher odds of complications after MIRPE compared to younger patients (<18 years).
Meta-analysis of 5,978 patients showed overall complication rate of 19.87%, with age as significant risk factor.
Specific complications more common in older patients: pneumothorax, pleural effusion, wound infection, bar displacement, reoperation.
Evidence supports performing MIRPE before late adolescence to minimize complication risk.
Optimal timing for pectus excavatum repair appears to be during childhood or early adolescence rather than adulthood.

Written by the GCMD Library team from the infographic.

The infographic uses a red and white color scheme with simple icon illustrations. On the left, a cross-sectional chest diagram shows the NUSS bar placement, with silhouettes comparing pediatric and adult patients. The right side displays three rows of complication data with downward arrows showing rates for younger versus older age groups. Icons represent the patient population and procedure.

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.

The text in the image

Read it at the source ↗