Multiple-Bar Repair for Pediatric Pectus Excavatum: A Large Propensity Score–Matched Cohort Study of Safety and Efficacy

Background: Surgical repair of pectus excavatum (PE) has evolved from simple sternal elevation toward comprehensive chest wall remodeling with multiple bars. However, concerns about postoperative pain and technical complexity have limited adoption of multiple-bar repair in children. We implemented multiple-bar repair across all age groups and evaluated its safety and efficacy in pediatric patients. Methods: Between November 2019 and November 2023, 469 patients underwent surgical PE repair; 210 pediatric patients aged 3-12 years met the inclusion criteria. Variables included deformity symmetry, the Haller index, postoperative complications, rescue analgesic use, and length of hospitalization. Propensity score matching (PSM) balanced baseline characteristics between single-bar and multiple-bar groups. Receiver operating characteristic (ROC) curve analysis identified an age threshold associated with multiple-bar selection. Results: In the unmatched cohort (single-bar group, n=82; multiple-bar group, n=128), patients undergoing multiple-bar repair were significantly older. The Haller index did not differ significantly between groups. Rates of pneumothorax, pleural effusion, and wound complications were similar, and bar dislocation occurred only in the single-bar group. Length of hospitalization was also comparable. After 1:1 PSM, 33 matched pairs were identified, and baseline characteristics were balanced between groups. The multiple-bar group had a shorter hospital stay (4.3 days vs. 4.8 days, p<0.01). ROC curve analysis identified age ≥7 years as the optimal cutoff associated with the selection of multiple-bar repair (area under the curve, 0.82). Conclusion: Multiple-bar repair was not associated with higher postoperative complication rates or rescue analgesic requirements and may be a safe, feasible option for selected pediatric patients with PE.