Age-Stratified Outcomes of the Nuss Procedure for Pectus Excavatum: Challenging the Association Between Younger Age and Inferior Correction.

Abstract

This study evaluates age-specific patterns and factors influencing incomplete correction after the Nuss procedure, challenging the premise that younger age inherently increases recurrence. A retrospective review was conducted on patients who underwent the Nuss procedure for pectus excavatum (2006-2021), with a minimum follow-up of 2 years after bar removal. Patients were stratified by operative age: Group A (3-6 years), Group B (7-10 years), Group C (11-14 years), and Group D (≥15 years). Perioperative parameters and outcomes were compared. Among 526 patients, the preoperative Haller index decreased with age (P < .001). Older groups demonstrated increased operative time, blood loss, bar use, and non-life-threatening complication rates (all P < .001). While the 6.3% (33/526) incomplete correction rate initially varied by age (P = .049), risk disparities became non-significant following adjustment for multiple comparisons. Presentation timing differed, with Group A showing delayed presentation within one year post-removal versus early detection within one month for Group D. Oblique bar placement, introduced in 2012, significantly reduced incomplete correction in the youngest group (12.2% to 3.3%, P = .020), without significant effect on other groups. No deterioration occurred in complete correction cases among all age groups. Younger age was associated with fewer postoperative complications. Incomplete correction rate was not age-dependent, but the underlying mechanisms varied among groups. Modifications in surgical technique and instrumentation significantly improved the complete correction rate.