Is it time to expand the surgical criteria? The psychosocial impact of pectus excavatum in pediatrics.

Abstract

The physiologic sequelae of pectus excavatum are well known; however, the impact on body image remains understudied. We aimed to assess the psychosocial impact of pectus excavatum in children and congruency with their parents. The Pediatric Quality-of-Life Inventory 4.0, Severity Measure for Social Anxiety Disorder, Short Form Mood and Feelings Questionnaire, and a chest wall appearance measure were administered to pediatric patients (<18 years) with pectus excavatum (August 2021 to July 2024). Outcomes were compared between 2 groups: mild-moderate (Haller index ≤3.24) and severe (Haller index ≥3.25). Fisher exact, Mann-Whitney U, and Spearman correlation tests were performed. Congruency was assessed with Wilcoxon-signed rank and Cohen Kappa. Of the 57 patients, 86% were male (median age 14 years [interquartile range, 13-15]). Thirty-one patients (54%) were severe. Impaired quality of life was seen in 53% of patients, no difference by Haller index (P = .78); 42% screened positive for anxiety, and 7% for depression, no difference by Haller index (P = .38). Regarding appearance, 42% reported being uncomfortable taking their shirt off in public, 38% felt different than others because of their chest shape, 40% were dissatisfied with the appearance of their body. Measures had moderate-to-strong correlation. Parent-patient dyads showed low congruency in quality-of-life (56% slight agreement) and body image (57% slight agreement). Children with pectus excavatum, regardless of severity, are at increased risk for social anxiety, depression, and negative body image. Parental concordance is low, suggesting need for patient-directed screening. Nonphysiologic criteria for repair, such as psychosocial factors, should be considered when treating pectus excavatum.