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National trends in pectus excavatum repair: patient age, facility volume, and outcomes

BACKGROUND: There is limited data on the adult repair of pectus excavatum (PE). Existing literature is largely limited to single institution experiences and suggests that adults undergoing modified Nuss repair may have worse outcomes than pediatric and adolescent patients. Using a representative nat...

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Autores principales: Mack, Shale J., Till, Brian M., Huang, Charles, Thosani, Darshak, Rahman, Uzma, Grenda, Tyler, Evans, Nathaniel R., Okusanya, Olugbenga T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9096322/
https://www.ncbi.nlm.nih.gov/pubmed/35572899
http://dx.doi.org/10.21037/jtd-21-1671
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author Mack, Shale J.
Till, Brian M.
Huang, Charles
Thosani, Darshak
Rahman, Uzma
Grenda, Tyler
Evans, Nathaniel R.
Okusanya, Olugbenga T.
author_facet Mack, Shale J.
Till, Brian M.
Huang, Charles
Thosani, Darshak
Rahman, Uzma
Grenda, Tyler
Evans, Nathaniel R.
Okusanya, Olugbenga T.
author_sort Mack, Shale J.
collection PubMed
description BACKGROUND: There is limited data on the adult repair of pectus excavatum (PE). Existing literature is largely limited to single institution experiences and suggests that adults undergoing modified Nuss repair may have worse outcomes than pediatric and adolescent patients. Using a representative national database, this analysis is the first to describe trends in demographics, outcomes, charges, and facility volume for adults undergoing modified Nuss procedure. METHODS: Because of a coding change associated with ICD-10, a retrospective cohort analysis using the National Inpatient Sample (NIS) for patients 12 or older undergoing modified Nuss repair between 2016–2018 was possible. Pearson’s χ(2) and Student’s t-tests were utilized to compare patient, clinical, and hospital characteristics. Complications were sub-classified into major and minor categories. Facilities performing greater than the mean number of operations were categorized as high-volume. RESULTS: Of 360 patients, 79.2% were male. There was near gender parity for patients over 30 undergoing repair (55.2% male, 44.8% female). In all age cohorts, patients were predominantly Caucasian. Rates of any postoperative complication differed by age (12–17 years: 30.6%; 18–29 years: 45.2%; 30+ years: 62.1%; P<0.01); older patients had higher rates of all but two subclasses of complication. Age over 30 was associated with higher charges (12–17 years: $57,312; 18–29 years: $57,001; 30+ years: $67,014; P<0.01). High-volume centers operate on older patients, had shorter lengths of stay, and comparable charges to low-volume centers. CONCLUSIONS: Women comprise nearly half of patients undergoing modified Nuss repair after 30 years of age. There are significant differences in complication rates and charges when comparing patients by age. Patients undergoing repair at high-volume facilities benefitted from shorter lengths of stay.
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spelling pubmed-90963222022-05-13 National trends in pectus excavatum repair: patient age, facility volume, and outcomes Mack, Shale J. Till, Brian M. Huang, Charles Thosani, Darshak Rahman, Uzma Grenda, Tyler Evans, Nathaniel R. Okusanya, Olugbenga T. J Thorac Dis Original Article BACKGROUND: There is limited data on the adult repair of pectus excavatum (PE). Existing literature is largely limited to single institution experiences and suggests that adults undergoing modified Nuss repair may have worse outcomes than pediatric and adolescent patients. Using a representative national database, this analysis is the first to describe trends in demographics, outcomes, charges, and facility volume for adults undergoing modified Nuss procedure. METHODS: Because of a coding change associated with ICD-10, a retrospective cohort analysis using the National Inpatient Sample (NIS) for patients 12 or older undergoing modified Nuss repair between 2016–2018 was possible. Pearson’s χ(2) and Student’s t-tests were utilized to compare patient, clinical, and hospital characteristics. Complications were sub-classified into major and minor categories. Facilities performing greater than the mean number of operations were categorized as high-volume. RESULTS: Of 360 patients, 79.2% were male. There was near gender parity for patients over 30 undergoing repair (55.2% male, 44.8% female). In all age cohorts, patients were predominantly Caucasian. Rates of any postoperative complication differed by age (12–17 years: 30.6%; 18–29 years: 45.2%; 30+ years: 62.1%; P<0.01); older patients had higher rates of all but two subclasses of complication. Age over 30 was associated with higher charges (12–17 years: $57,312; 18–29 years: $57,001; 30+ years: $67,014; P<0.01). High-volume centers operate on older patients, had shorter lengths of stay, and comparable charges to low-volume centers. CONCLUSIONS: Women comprise nearly half of patients undergoing modified Nuss repair after 30 years of age. There are significant differences in complication rates and charges when comparing patients by age. Patients undergoing repair at high-volume facilities benefitted from shorter lengths of stay. AME Publishing Company 2022-04 /pmc/articles/PMC9096322/ /pubmed/35572899 http://dx.doi.org/10.21037/jtd-21-1671 Text en 2022 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Mack, Shale J.
Till, Brian M.
Huang, Charles
Thosani, Darshak
Rahman, Uzma
Grenda, Tyler
Evans, Nathaniel R.
Okusanya, Olugbenga T.
National trends in pectus excavatum repair: patient age, facility volume, and outcomes
title National trends in pectus excavatum repair: patient age, facility volume, and outcomes
title_full National trends in pectus excavatum repair: patient age, facility volume, and outcomes
title_fullStr National trends in pectus excavatum repair: patient age, facility volume, and outcomes
title_full_unstemmed National trends in pectus excavatum repair: patient age, facility volume, and outcomes
title_short National trends in pectus excavatum repair: patient age, facility volume, and outcomes
title_sort national trends in pectus excavatum repair: patient age, facility volume, and outcomes
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9096322/
https://www.ncbi.nlm.nih.gov/pubmed/35572899
http://dx.doi.org/10.21037/jtd-21-1671
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