Analysis Of The Causes And Related Factors Of Complications In Wang Procedure And Modified Nuss Procedure For Pectus Excavatum

Objective:According to the clinical data of patients with pectus excavatum treated by Wang procedure and modified Nuss procedure with incisions<3 cm,to analyze the causes of common surgical complications in combination with clinical experience and literature research,to explore the related factors affecting the occurrence of surgical complications and the management measures to prevent surgical complications in the perioperative period,and to provide reference and practice basis for the prevention and treatment of complications of pectus excavatum with small incisions in the chest wall.Methods:A retrospective study of clinical data that some patients who underwent surgical treatment of pectus excavatum in the the Department of Chest Wall Surgery,Guangdong Second Provincial General Hospital from July 1,2018 to July 31,2021,including 152 cases of Wang procedure and 293 cases of modified Nuss procedure.And the follow-up period was up to December 31,2021.The collected data included the patient’s gender,age,height,weight,comorbidities,previous surgical history,severity of pectus excavatum,preoperative white blood cell count,preoperative albumin count,whether the bar was removed,and the duration of indwelling bar;intraoperative incision position,direction,number,length,suture selection,suture method;surgical anesthesia method,total operation time,blood loss,number of bar,number of wires fixed on each side of the incision,postoperative analgesic pump usage,postoperative drainage,time of postoperative hospital stay,and surgical complications.Firstly,to descriptive analyze the clinical applications of the two surgical modalities based on the clinical data.Secondly,including some clinical data as independent variables,and the occurrence of surgical complications as dependent variables.To explore the factors associated with the occurrence of complications in the Wang procedure and the modified Nuss procedure by using the method of multivariate binary Logistic regression analysis.Results:445 patients with pectus excavatum successfully completed surgery.The median age of all patients was 13.58 years old,the youngest was 11 months old,and the oldest was 45 years old.The median age of Wang procedure patients was 4.08 years old,and the median age of modified Nuss procedure patients was 15.00 years old.The median BMI of all patients was 16.44.The median total operation time of all patients was 53 minutes,the shortest was 20 minutes,and the longest was 163 minutes.The median operation time of Wang procedure was 43 minutes,which was shorter than the median operation time of the modified Nuss procedure of 59 minutes.The median time of postoperative hospital stay was 6 days in the Wang procedure,which was shorter than 7 days in the modified Nuss procedure.There were 48 patients who occured complications requiring clinical intervention in all included patients,including 19 cases of incision complications,21 cases of pleural effusion,3 cases of pneumothorax,4 cases of pneumonia,2 cases of bleeding,1 case of bar displacement,1 case of poor recovery and rehospitalization,and 1 case of decreased oxygen saturation after surgery.Among them,4 cases had multiple complications.The univariate results of binary Logistic regression analysis showed that age(OR=1.048,P=0.005),total operation time(OR=1.016,P=0.016),2 steel bars(OR=2.057,P=0.047),3 steel bars(OR=5.190,P=0.013)were associated with complications.Multifactorial results showed that age<6 years(P=0.020),age>13 years(OR=5.641,P=0.023)was statistically significant,indicating that the risk of complications was 5.641 times higher in patients aged>13 years compared with those aged<6 years.Conclusion:Both the Wang procedure and the modified Nuss procedure are minimally invasive and effective options for the treatment of pectus excavatum.Wang procedure is suitable for young children with pectus excavatum.The most common postoperative complication is poor incision healing.The modified Nuss procedure is mostly performed on patients in adolescence,and the most common postoperative complication is pleural effusion.Multifactorial binary Logistic regression analysis showed that patiens aged>13 years were more likely to develop complications than patients aged<6 years,suggesting that patients with pectus excavatum who have surgical indications can choose early surgery.