Prospective Multicenter Study of Surgical Correction of Pectus Excavatum: Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection

Robert E. Kelly, Robert C. Shamberger, Robert B. Mellins, Karen K. Mitchell, M. Louise Lawson, Keith Oldham, Richard G. Azizkhan, Andre V. Hebra, Donald Nuss, Michael J. Goretsky, Ronald J. Sharp, George W. Holcomb, Walton K T Shim, Stephen M. Megison, R. Lawrence Moss, Annie H. Fecteau, Paul Colombani, Traci C. Bagley, Alan B. Moskowitz

Research output: Contribution to journalArticle

Abstract

Background: Given widespread adoption of the Nuss procedure, prospective multicenter study of management of pectus excavatum by both the open and Nuss procedures was thought desirable. Although surgical repair has been performed for more than 50 years, there are no prospective multicenter studies of its management. Study Design: This observational study followed pectus excavatum patients treated surgically at 11 centers in North America, according to the method of choice of the patient and surgeon. Before operation, all underwent evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, hospital complications, and perioperative pain. One year after completion of treatment, patients will repeat the preoperative evaluations. This article addresses early results only. Results: Of 416 patients screened, 327 were enrolled; 284 underwent the Nuss procedure and 43 had the open procedure. Median preoperative CT index was 4.4. Pulmonary function testing before operation showed mean forced vital capacity of 90% of predicted values; forced expiratory volume in 1 second (FEV1), 89% of predicted; and forced expiratory flow during the middle half of the forced vital capacity (FEF25% to 75%), 85% of predicted. Early postcorrection results showed that operations were performed without mortality and with minimal morbidity at 30 days postoperatively. Median hospital stay was 4 days. Postoperative pain was a median of 3 on a scale of 10 at time of discharge; the worst pain experienced was the same as was expected by the patients (median 8), and by 30 days after correction or operation, the median pain score was 1. Because of disproportionate enrollment and similar early complication rates, statistical comparison between operation types was limited. Conclusions: Anatomically severe pectus excavatum is associated with abnormal pulmonary function. Initial operative correction performed at a variety of centers can be completed safely. Perioperative pain is successfully managed by current techniques.

Original languageEnglish (US)
Pages (from-to)205-216
Number of pages12
JournalJournal of the American College of Surgeons
Volume205
Issue number2
DOIs
StatePublished - Aug 2007
Externally publishedYes

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Funnel Chest
Internet
Multicenter Studies
Prospective Studies
Pain
Lung
Vital Capacity
Body Image
Respiratory Function Tests
Forced Expiratory Volume
Postoperative Pain
North America
Observational Studies
Length of Stay
Morbidity
Mortality

ASJC Scopus subject areas

  • Surgery

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Prospective Multicenter Study of Surgical Correction of Pectus Excavatum : Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection. / Kelly, Robert E.; Shamberger, Robert C.; Mellins, Robert B.; Mitchell, Karen K.; Lawson, M. Louise; Oldham, Keith; Azizkhan, Richard G.; Hebra, Andre V.; Nuss, Donald; Goretsky, Michael J.; Sharp, Ronald J.; Holcomb, George W.; Shim, Walton K T; Megison, Stephen M.; Moss, R. Lawrence; Fecteau, Annie H.; Colombani, Paul; Bagley, Traci C.; Moskowitz, Alan B.

In: Journal of the American College of Surgeons, Vol. 205, No. 2, 08.2007, p. 205-216.

Research output: Contribution to journalArticle

Kelly, RE, Shamberger, RC, Mellins, RB, Mitchell, KK, Lawson, ML, Oldham, K, Azizkhan, RG, Hebra, AV, Nuss, D, Goretsky, MJ, Sharp, RJ, Holcomb, GW, Shim, WKT, Megison, SM, Moss, RL, Fecteau, AH, Colombani, P, Bagley, TC & Moskowitz, AB 2007, 'Prospective Multicenter Study of Surgical Correction of Pectus Excavatum: Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection', Journal of the American College of Surgeons, vol. 205, no. 2, pp. 205-216. https://doi.org/10.1016/j.jamcollsurg.2007.03.027
Kelly, Robert E. ; Shamberger, Robert C. ; Mellins, Robert B. ; Mitchell, Karen K. ; Lawson, M. Louise ; Oldham, Keith ; Azizkhan, Richard G. ; Hebra, Andre V. ; Nuss, Donald ; Goretsky, Michael J. ; Sharp, Ronald J. ; Holcomb, George W. ; Shim, Walton K T ; Megison, Stephen M. ; Moss, R. Lawrence ; Fecteau, Annie H. ; Colombani, Paul ; Bagley, Traci C. ; Moskowitz, Alan B. / Prospective Multicenter Study of Surgical Correction of Pectus Excavatum : Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection. In: Journal of the American College of Surgeons. 2007 ; Vol. 205, No. 2. pp. 205-216.
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abstract = "Background: Given widespread adoption of the Nuss procedure, prospective multicenter study of management of pectus excavatum by both the open and Nuss procedures was thought desirable. Although surgical repair has been performed for more than 50 years, there are no prospective multicenter studies of its management. Study Design: This observational study followed pectus excavatum patients treated surgically at 11 centers in North America, according to the method of choice of the patient and surgeon. Before operation, all underwent evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, hospital complications, and perioperative pain. One year after completion of treatment, patients will repeat the preoperative evaluations. This article addresses early results only. Results: Of 416 patients screened, 327 were enrolled; 284 underwent the Nuss procedure and 43 had the open procedure. Median preoperative CT index was 4.4. Pulmonary function testing before operation showed mean forced vital capacity of 90{\%} of predicted values; forced expiratory volume in 1 second (FEV1), 89{\%} of predicted; and forced expiratory flow during the middle half of the forced vital capacity (FEF25{\%} to 75{\%}), 85{\%} of predicted. Early postcorrection results showed that operations were performed without mortality and with minimal morbidity at 30 days postoperatively. Median hospital stay was 4 days. Postoperative pain was a median of 3 on a scale of 10 at time of discharge; the worst pain experienced was the same as was expected by the patients (median 8), and by 30 days after correction or operation, the median pain score was 1. Because of disproportionate enrollment and similar early complication rates, statistical comparison between operation types was limited. Conclusions: Anatomically severe pectus excavatum is associated with abnormal pulmonary function. Initial operative correction performed at a variety of centers can be completed safely. Perioperative pain is successfully managed by current techniques.",
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T2 - Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection

AU - Kelly, Robert E.

AU - Shamberger, Robert C.

AU - Mellins, Robert B.

AU - Mitchell, Karen K.

AU - Lawson, M. Louise

AU - Oldham, Keith

AU - Azizkhan, Richard G.

AU - Hebra, Andre V.

AU - Nuss, Donald

AU - Goretsky, Michael J.

AU - Sharp, Ronald J.

AU - Holcomb, George W.

AU - Shim, Walton K T

AU - Megison, Stephen M.

AU - Moss, R. Lawrence

AU - Fecteau, Annie H.

AU - Colombani, Paul

AU - Bagley, Traci C.

AU - Moskowitz, Alan B.

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N2 - Background: Given widespread adoption of the Nuss procedure, prospective multicenter study of management of pectus excavatum by both the open and Nuss procedures was thought desirable. Although surgical repair has been performed for more than 50 years, there are no prospective multicenter studies of its management. Study Design: This observational study followed pectus excavatum patients treated surgically at 11 centers in North America, according to the method of choice of the patient and surgeon. Before operation, all underwent evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, hospital complications, and perioperative pain. One year after completion of treatment, patients will repeat the preoperative evaluations. This article addresses early results only. Results: Of 416 patients screened, 327 were enrolled; 284 underwent the Nuss procedure and 43 had the open procedure. Median preoperative CT index was 4.4. Pulmonary function testing before operation showed mean forced vital capacity of 90% of predicted values; forced expiratory volume in 1 second (FEV1), 89% of predicted; and forced expiratory flow during the middle half of the forced vital capacity (FEF25% to 75%), 85% of predicted. Early postcorrection results showed that operations were performed without mortality and with minimal morbidity at 30 days postoperatively. Median hospital stay was 4 days. Postoperative pain was a median of 3 on a scale of 10 at time of discharge; the worst pain experienced was the same as was expected by the patients (median 8), and by 30 days after correction or operation, the median pain score was 1. Because of disproportionate enrollment and similar early complication rates, statistical comparison between operation types was limited. Conclusions: Anatomically severe pectus excavatum is associated with abnormal pulmonary function. Initial operative correction performed at a variety of centers can be completed safely. Perioperative pain is successfully managed by current techniques.

AB - Background: Given widespread adoption of the Nuss procedure, prospective multicenter study of management of pectus excavatum by both the open and Nuss procedures was thought desirable. Although surgical repair has been performed for more than 50 years, there are no prospective multicenter studies of its management. Study Design: This observational study followed pectus excavatum patients treated surgically at 11 centers in North America, according to the method of choice of the patient and surgeon. Before operation, all underwent evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, hospital complications, and perioperative pain. One year after completion of treatment, patients will repeat the preoperative evaluations. This article addresses early results only. Results: Of 416 patients screened, 327 were enrolled; 284 underwent the Nuss procedure and 43 had the open procedure. Median preoperative CT index was 4.4. Pulmonary function testing before operation showed mean forced vital capacity of 90% of predicted values; forced expiratory volume in 1 second (FEV1), 89% of predicted; and forced expiratory flow during the middle half of the forced vital capacity (FEF25% to 75%), 85% of predicted. Early postcorrection results showed that operations were performed without mortality and with minimal morbidity at 30 days postoperatively. Median hospital stay was 4 days. Postoperative pain was a median of 3 on a scale of 10 at time of discharge; the worst pain experienced was the same as was expected by the patients (median 8), and by 30 days after correction or operation, the median pain score was 1. Because of disproportionate enrollment and similar early complication rates, statistical comparison between operation types was limited. Conclusions: Anatomically severe pectus excavatum is associated with abnormal pulmonary function. Initial operative correction performed at a variety of centers can be completed safely. Perioperative pain is successfully managed by current techniques.

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