Bar-Related Infections After Minimally Invasive Repair of Pectus Excavatum: A 25-Year Single-Center Retrospective Cohort Study

Introduction This study aims to evaluate the incidence and characteristics of Nuss bar infections, identify factors associated with infection, and present our institutional management considerations. Materials and methods We conducted a single-center retrospective cohort study of patients undergoing the Nuss procedure between 1999-2024 at Amsterdam Pectus Center. All patients had a minimum follow-up of six months. Primary outcomes included incidence and management of infections. Secondary outcomes included infection characteristics (early- (<30days) versus late-onset (>30days), superficial versus deep), diagnostics, microbiology, factors associated with infection (sex, age, type of anesthesia, number of bars, bar dislocation, stabilizer position, use of sutures), impact on bar removal, incidence of allergies and terra firma-forme dermatosis. Results Of 695 patients, 4.0% (n=28/695) developed Nuss bar infections, at a median 2.0 (0.0-13.5) months postoperative, presenting with erythema, pain, exudate. Over time, infections shifted from early- to late-onset (P=.03). Deep infections (71.4%, n=20/28) more often required surgery (P=.007), superficial infections were managed with a wide range of antibiotics. Bar dislocations (5.6%, n=39/695) and stabilizer plate loosening (1.0%, n=7/695) required reoperation and were associated with infections (P=.001). Operative time for bar removal was longer in infected patients (52.0 (32.0-68.0) versus 35.0 (26.0-49.0) minutes, P=.03). One case of cobalt allergy was identified. Terra firma-forme dermatosis (0.4%, n=3/695) was treated with alcohol wipes. Conclusions Bar dislocation and stabilizer plate loosening are associated with Nuss bar infections. We present our institutional management considerations based on retrospective data and experience, requiring prospective validation. Accurate diagnostics, tailored antibiotic therapy, and consideration of alternative diagnoses remain essential.