The role of age and severity of deformity in the choice of treatment for pectus carinatum: a comparison of braces and surgical correction

BACKGROUND: Pectus carinatum (PC) is a congenital chest wall deformity that can lead to aesthetic, functional and psychosocial problems, especially in adolescence. The choice of treatment usually depends on clinical factors such as the severity of the deformity, the stiffness of the chest wall and the age of the patient. This study aimed to compare the clinical outcomes of conservative and surgical treatment modalities for PC and to examine the associations among age, deformity severity and treatment selection. METHODS: A retrospective review of 118 patients treated between 2009 and 2022 was conducted. Patients were categorized into three groups on the basis of their clinical characteristics: dynamic bracing (n = 53), the Abramson procedure (n = 57), and the Ravitch procedure (n = 8). The primary outcomes included aesthetic satisfaction, functional improvement, the complication rate, and overall patient satisfaction. Patient-reported outcomes were assessed using a structured but nonvalidated questionnaire developed by the authors and reviewed by a multidisciplinary panel. RESULTS: A statistically significant association was observed between patient age and deformity severity (P = 0.021). Aesthetic satisfaction scores were significantly higher in the Abramson group than in the bracing group (mean: 4.6 ± 0.3 vs. 4.1 ± 0.4, P < 0.001). Functional improvement was observed across all treatment groups, with a nonsignificant trend favoring surgical interventions (P = 0.089). The complication rate was highest in the Ravitch group (25.0%) and lowest in the bracing group (3.7%) (P = 0.013). In this retrospective cohort, overall patient satisfaction scores were highest in patients treated with the Abramson procedure (mean: 9.0 ± 0.8, P < 0.001). The presence of syndromic or systemic comorbidities was not significantly associated with clinical outcomes. CONCLUSION: Patient age and deformity severity were associated with treatment selection in PC. In this cohort, surgical correction, particularly the Abramson procedure, was associated with higher aesthetic satisfaction and overall patient-reported satisfaction in appropriately selected patients. However, given the retrospective study design and the use of a nonvalidated patient-reported outcome measure, these findings should be interpreted with caution. Further prospective studies using standardized and validated outcome measures are warranted to confirm these observations.