Complication Rate of the Nuss Procedure in Adults and Pediatric Patients: National Database Analysis

BACKGROUND: Pectus excavatum (PE) is the most common congenital chest wall defect characterized by the inward displacement of the sternum and costal cartilages. To date, there is limited data on adult patients undergoing the Nuss procedure for PE. This study aims to assess the complication rate between the pediatric and adult populations and assess the trends in demographics. background METHODS Retrospective analysis was conducted using a global healthcare database TriNetX. CPT codes (21742, 21743) were used to identify all patients that underwent Nuss procedures in the years 2004-2023. The cohort was then sub-divided based on age and gender. They were assessed for 30-day and 90-day major and minor postoperative complications as well as acute pain and chronic postoperative pain. RESULTS A total of 2,843 patients who underwent Nuss repair were identified. Patients >18 years old had increased hemorrhagic complications 3% vs 0.86% in patients <18 years old (p<0.001) and acute pain: 55% in patients > 18 years old vs 39.1% in patients <18 years old, (p<0.001). Overall complication rates were 28.48% in females and 21.7% in males (p=0.0014). Females had higher rates of respiratory complications: 6% vs. 2.7% in males (p=0.001), chronic pain: 5.2% in females vs. 2% in males (p<0.001) and hemorrhagic complications: 6% in females vs. 0.97% in males (p=0.0042). CONCLUSIONS This study suggests that adults experience significantly increased post operative pain and hemorrhagic complications when compared to the pediatric population. Females experience significantly higher complication rates when compared to males in all age groups.