Surgical correction of 639 pectus excavatum cases via the Nuss procedure

Background: To review the clinical experience and short-to middle-term effects of the Nuss procedure for correction of pectus excavatum (PE). Methods: From September 2006 to August 2014, 639 patients with PE were treated using the Nuss procedure. Of these, 546 were male and 93 were female. The mean age was 15.3 +/- 5.8 years (2.5-49 years). Preoperative chest CT scans Haller index (HI) was 4.3 +/- 1.7 (2.9-17.4), with 75 cases of mild PE (HI <3.2), 114 cases of moderate PE (HI 3.2-3.5), 393 cases of severe PE (HI 3.6-6.0), and 57 cases of extremely severe PE (HI >6.0). Results: A total of 638 patients successfully completed the surgery, an 11-year-old male patient who died after the surgery had undergone ventricular septal defect closure surgery through a sternal incision 7 years ago. The mean operative time was 64.3 +/- 41.7 min (40-310 min). Excluding the patient who died, the average blood loss was 24.5 +/- 17.8 mL (10-160 mL). The average length of postoperative hospital stay was 5.2 +/- 2.9 days (4-36 days). A total of 484 cases (75.7%) required 1 steel bar insertion, 153 cases (24.0%) required 2 steel bars, and 2 cases (0.3%) required 3 bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 504 cases, good in 105, fair in 28 and poor in 2, good quality rate was 95.3%. Conclusions: Correction of PE via the Nuss procedure is minimally invasive and simple to perform with good short and mid-term effects, while long-term efficacy remains to be determined.