Elective pectus bar removal following Nuss procedure for pectus excavatum: a single-institution experience

Objective: Very few data are available on complications following elective bar removal after the Nuss procedure for pectus excavatum. The objective of this study was to investigate the data from 343 consecutive patients. Methods: From 2003 to 2009, 343 patients (85% males) had their pectus bar removed. Nine patients were excluded because of bar removal within the first year after implantation. Data were recorded from hospital records regarding: operation time, formation of callus around the bar, unilateral or bilateral incision, complications, postoperative hospital stay and if a senior resident or an intern performed the operation. Results: The median age at the time of bar removal was 19.1 years. The median time for removal after insertion of the bar was 1139 days (range 641-2575 days). The median operation time was 34 min (range 5183 min). The operation time depended on the formation of callus around the bar (p < 0.0001), numbers of bars to be removed (p < 0.0002), the need for bilateral incision (p < 0.0001) and the charge of the surgeon performing the operation (p < 0.0008). Eight patients (2.4%) had complications after the surgery. Five patients had pneumothorax, of which three were treated with chest tubes, and two controlled with chest Xray. Three patients had hemothorax. Two were treated with a chest tube and the third required open surgery. Most of the patients were discharged on the day of surgery (94%) or the day after surgery (4%). Only six (2%) required more than a single day of hospitalization. Conclusions: Bar removal following the Nuss procedure is a quick and safe operation with very few complications. Occurrence of complications is not dependent on the experience of the surgeon. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B. V. All rights reserved.