Infections following minimally invasive repair of pectus excavatum in pediatric patients: a multi-institutional retrospective cohort study of the Western Pediatric Surgery Research Consortium

Purpose: This multicenter study aims to describe the rate of postoperative infectious complications following minimally invasive repair of pectus excavatum (MIRPE) and explore the various approaches to treatment of these infections. Methods: A retrospective review of patients ≤ 21 years of age who underwent MIRPE between 7/2022 and 10/2023 across 10 children's hospitals was conducted. Patient demographics, clinical characteristics, operative details, and postoperative outcomes were collected and analyzed. Results: A total of 523 pediatric patients met inclusion criteria; 450 (86.5%) were males. Postoperative infection occurred in 17 patients (3.3%): 5 superficial surgical site infections (SSI) (29.4%) and 12 deep bar infections (70.6%). There were no significant differences in demographics, clinical characteristics, or operative details between patients with and without postoperative infection, except for race. The proportion of patients with one, two or three bars differed between those with and without superficial SSIs (p = 0.002). There was no significant difference in number of bars placed for patients with or without bar infection. All but one postoperative deep bar infection (91.7%) were managed with bar salvage. Conclusions: The overall incidence of postoperative infectious complications after MIRPE is low. Most deep bar infections can be managed with antibiotics and washout, without need for bar replacement or early removal.