Contemporary management of pectus excavatum: A survey of the members of the American pediatric surgical association

Widespread adoption and use of the Nuss procedure have led to numerous refinements and innovations in managing children with pectus excavatum (PE). Our aim in this project was to determine the common clinical and operative practices pediatric surgeons employ to care for children with PE. Additionally, we sought to identify opportunities to optimize current PE management strategies. A 28-question IRB-approved survey was administered electronically to all APSA members. The American Pediatric Surgical Association (APSA) outcomes committee sanctioned the survey content. 140 members responded to the survey. We received responses from members in 36 states, with 97% performing the Nuss procedure at either a children’s hospital or a children’s center within an adult hospital. Cryoablation is the most common pain management routine (84%), and a majority use a commercially available titanium system (60%). There is variability in the technical aspects of passing the bar, with a most common approach of right thoracoscopy with bar passage right-to-left (51%). Notably, 33% have adopted intermittent or synchronous use of bilateral thoracoscopy. Use of stabilizer plates is routine (81%). Only 56% limit activities until >12 weeks post-op, with a remainder offering more liberal return to activity. Complications experienced by the respondent or a partner included bar migration requiring reoperation (76%), hemorrhage during insertion requiring intervention (17%), and hemorrhage during removal requiring intervention (20%). The survey describes the contemporary pediatric surgeon practice patterns with respect to pectus excavatum correction, including workup, surgical indication, and the use of cryoablation. There is a wide variety of successful technical approaches. Allergy testing is not commonly used, and very few surgeons offer correction at younger than 12 years. Prolonged activity restrictions may be overly conservative. Bar migration and bleeding complications may be more common than the reported incidence. Collaborative opportunities to harmonize the factors surveyed may be indicated. IRB approval number: 00000654