O3292: Minimally Invasive Repair of Pectus Excavatum Without Stabilizers Does Not Result in Increased Bar Displacement or Other Post-operative Complications

Background: Since the Nuss procedure was first performed in the 1990s, surgeons have adopted various modifications and techniques that vary by practice to optimize patient outcomes and minimize complications following pectus excavatum repair. Bar dislocation is a particularly dreaded complication, and as such, many Nuss bars are secured using unilateral or bilateral stabilizers. However, additional foreign body use can be associated with increased morbidity such as infection at stabilizer sites (approximately 3% incidence), and pain attributed to stabilizer presence. Beginning in 2020, individuals in our practice did not place stabilizers in patients undergoing minimally invasive repair of pectus excavatum (MIRPE), and instead, secured the bar with bilateral FiberWire, two-point Tevdek, or Vicryl fixation. All patients received cryoablation intra-operatively and there were no adjustments in post-operative restrictions, which aimed for return to normal activity two weeks after surgery. In this study, we aim to evaluate morbidity and patient outcomes in patients who undergo MIRPE without stabilizer use.

Methods: This is a single-institution, retrospective review of all patients undergoing MIRPE without stabilizers during Nuss bar placement. Demographics were recorded, as well as Haller index, corrective index, presence of post-operative infection, post-operative analgesia use, length of stay, and any instance of bar displacement. All values are reported as medians with interquartile range (IQR).

Results: A total of 26 patients since 2020 underwent MIRPE without stabilizer placement. The cohort was predominantly male (85%, n=22) with a median age at the time of bar placement of 15 years (IQR 14,17), a median Haller index of 4 (IQR 3.6,4.6), and median corrective index of 25 (IQR 17,44). Median time from surgery was 11 months (IQR 3,16). Thirty one percent (n=8) of patients were discharged home the same day as surgery, 62% (n=16) were discharged home on post-op day 1, and 7% (n=2) stayed more than one day post-op (one due to pain and one due to a management of post-op pneumothorax). Zero patients experienced bar displacement, surgical site infection, or hospital re-admission related to surgery. Thirteen patients could recount post-op opioid use. For these patients, the median number of days following discharge that they required opioids was 5 (IQR 3,7). Of 22 patients at their one-month follow-up appointment, 73% (n=16) were no longer regularly using any form of over the counter (e.g., Tylenol, ibuprofen) analgesia for post-op pain.

Conclusion: Nuss bar placement without stabilizers is a safe means of correcting pectus excavatum without increased risk of bar displacement. Minimizing the amount of foreign material has the potential to mitigate post-operative infection, irritation, and pain from surgery.