Effect of activity restrictions on pectus bar displacement following minimally invasive repair of pectus excavatum - A Western Pediatric Surgery Research Consortium

Introduction: Activity restrictions following the minimally invasive repair of pectus excavatum (MIRPE) are often given with the intention of reducing pectus bar displacement (PBD). We aimed to assess the effect of activity restrictions on PBD following MIPRE. Methods: A ten-center retrospective review was conducted among patients <21 years undergoing MIRPE between 7/1/2022-10/31/2023. Postoperative activity restrictions were categorized into two groups: no restrictions versus any activity restrictions. PBD was defined as bar migration requiring reoperation within 90 days of MIRPE. We compared the incidence of PBD and postoperative outcomes between cohorts. Results: A total of 532 patients were included (mean age - 15.9 ± 2.0 years, male - 86 %, median Haller index - 4.5 [IQR:3.8-5.8]). Postoperatively, 24 % of patients (127/532) were not given activity restrictions. Patients with activity restriction had a higher proportion of pericostal suture use (78 % vs 43 %, p < 0.001) and subpectoral tunneling (58 % vs 36 %, P < 0.001), and a lower proportion of sternal elevation (63 % vs 80 %, p < 0.001) and cryoanalgesia (88 % vs 100 %, p < 0.001) during MIRPE. Overall, PBD occurred in 1.6 % of patients, with no difference in the incidence of PBD between those patients with and without activity restrictions (1.7 % vs 0.8 %, p = 0.468). Additionally, there were no significant differences in other postoperative complications between these groups. Conclusion: Ad libitum physical activit