Quality of life of patients who have undergone the minimally invasive repair of pectus carinatum (original) (raw)
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Quality of life improves after minimally invasive repair of pectus excavatum
Asian cardiovascular & thoracic annals, 2015
Background: Pectus excavatum is the most common chest wall deformity. This deformity may cause physical limitations and psychosocial problems. In this study, we aimed to investigate the effect of minimally invasive repair of pectus excavatum on the quality of life. Methods: This study included 88 patients, aged 18.44 AE 3.93 years (85.2% male), who underwent minimally invasive repair of pectus excavatum; 40.9% had an associated anomaly or disease, and 17.0% had scoliosis. The patients and their parents completed the patient and parent forms of the Nuss questionnaire modified for adults preoperatively and 6 months after the operation. Results: The patients' median Nuss score increased from 31 (interquartile range 31-35) preoperatively to 43 (interquartile range 43-46) at 6 months after the operation (p ¼ 0.000). The parents' preoperative score of 33 (interquartile range 29-36) increased to 38 (interquartile range 34-41; p ¼ 0.000). Improvements in the physical and psychosocial component scores of the Nuss questionnaire were also significant in the patient (p ¼ 0.000, p ¼ 0.000, respectively) and parent forms (p ¼ 0.005, p ¼ 0.000, respectively). Conclusions: Minimally invasive repair of pectus excavatum significantly improved the physical and psychosocial wellbeing of patients. Longitudinal studies are needed to determine the long-term changes related to quality of life.
Journal of Pediatric Surgery, 2003
Background: This study was conducted to determine the ability of 2 questionnaires (ie, child and parent versions) to measure physical and psychosocial quality-of-life changes after surgical repair of pectus excavatum. Methods: The authors administered these questionnaires by telephone interviews with 22 parents and 19 children (ages 8 to 18) before surgery and 6 to 12 months after repair by the Nuss procedure. Results: The instruments had high test-retest reliability (Rho Ͼ 0.6 for all retained questions). Children reported significant improvements in exercise intolerance, shortness of breath, and tiredness. Of 9 questions asking the children how they feel or act about their bodies, all but one question showed significant improvement after surgery. Parents also reported significant improvements in their child's exercise tolerance, chest pain, shortness of breath, and tiredness and decreases in the frequency of the child being frustrated, sad, self-conscious, and isolated. Conclusions: These questionnaires appear to be more than adequate to measure disease-specific quality-of-life changes after surgery. These data confirm for the first time that surgical repair of pectus excavatum has a positive impact on both the physical and psychosocial well-being of the child.
A prospective study on quality of life in youths after pectus excavatum correction
Annals of Cardiothoracic Surgery, 2016
Background: The impact of correction of pectus excavatum (PE) on adolescents' health-related quality of life (HRQL) has only been investigated in prospective designs using disease-specific measures and without controls. The aim of this prospective study was to evaluate the HRQL before and after surgical correction of PE using a generic HRQL measure, and to compare the reported level of HRQL before surgery with an age-comparable control group. Methods: Patients (n=107) and one of their parents (n=106) completed the generic HRQL measure: the Child Health Questionnaire before, 3 months, and 6 months after correction for PE. A control group (n=183) consisting of school children comparable in age completed the same measure on one occasion. Results: The patients' level of HRQL before surgery was comparable to the level of the controls except for physical functioning; here boys reported impaired function compared to controls (P<0.0001, d=0.72). Both patients and parents reported improved emotional wellbeing and self-esteem, as well as an increase in physical and social activities from pre-to post-surgery. These improvements were statistically significant (P≤0.001-0.03) and yielded moderate to high effect sizes (ƞ 2 =0.04-0.22). Conclusions: The improvement of physical and psychosocial HRQL reported by both patients and their parents as proxy indicates the psychological implications of the deformity. Patients reported impaired physical function compared to controls. Further, pre-surgery differences in HRQL between the patients and the controls were lacking. However, the improvement in the patients' HRQL following surgery may justify the correction of pectus excavatum. The effect of the deformity on patients wellbeing compared with controls' needs to be addressed in further studies.
Journal of Pediatric Surgery, 2003
Background/Purpose: The current project is a preliminary qualitative exploration of changes in quality of life of patients who have undergone the Nuss Procedure. The current study explores quality of life after surgical repair from the perspectives of both the patients and the parent(s) of the younger participants. Methods: This research constitutes the first segment in a mixed-method longitudinal design. The author conducted semistructured interviews based on the Keith and Schalock's quality of life model. Five youth who have undergone the Nuss Procedure and the parent(s) of the 4 younger participants were included in the study for a total of 10 participants. Textual analysis has been carried out using Atlas.ti, a qualitative data analysis program that facilitates such activities as selecting, coding, and comparing textual segments. Results: Results based on these preliminary data indicate that the patients interviewed had significant improvement in overall quality of life, which they attributed to the surgery. Specific examples of patients' expressions of improved selfconfidence and renewed interest in physical activity are given. Conclusions: The Nuss Procedure is a minimally invasive surgical option for correcting pectus excavatum deformities that may make important contributions to patients' selfperceptions and quality of life. The participants in the current study expressed satisfaction with both the physical results of the surgery and with how it improved their overall quality of life. The authors recommend further prospective longitudinal research that assesses pre-and postsurgery psychosocial status and the maintenance of perceived quality of life changes.
The Influence of Pain: Quality of Life after Pectus excavatum Correction
Introduction: The main indication for surgery of thoracic wall deformities (TWD) is psychological due to cosmetic complaints. The assumption is that appearances have a negative effect on self-esteem and quality of life (QoL). Correction should result in improvement. Methods: Prospective trial. QoL was assessed using the CHQ and the WHOQOL-bref. Measurements were taken before surgery (T1) and 6 weeks thereafter (T2). Results: Forty-two patients were included. WHOQOL-bref showed differences between pre-operative and six weeks past surgery on facet body image (p = 0.003). Self-esteem (CHQ) did not show a significant improvement at T2. Concerning the scores on the single step questionnaire (SSQ), 33 patients were “very” to “extremely satisfied” with appearance and increased self-esteem (p < 0.001). Concerning the domain “pain and physical complaints”, CHQ did show a significant change (p < 0.001) with more complaints at T2. Conclusion: Six weeks after surgical correction of a TWD satisfaction with the “new” chest is good; pain seems to be a problem with possible negative influence on self-esteem.
Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity
European Journal of Cardio-Thoracic Surgery, 2006
Objective: The Nuss procedure is a minimally invasive pectus repair. This study represents an attempt towards exploring the changes in quality of life and overall satisfaction in young male adults who underwent a Nuss procedure. Methods: We have included 20 male patients with a median age of 18 years (range: 14-37 years). We have used two specific questionnaires: the two-step Nuss evaluation Questionnaire modified for Adults (NQ-mA) and a new Single Step Questionnaire (SSQ). The data was analysed using Wilcoxon signed rank test to determine statistical significance of differences, with a <0.05 level of significance. Spearman's correlation coefficient was used to assess the correlation between the answers. Results: The primary indication for surgery was cosmetic. Both questionnaires were adequate to measure disease-specific quality-of-life changes after surgery and were able to confirm the positive impact of surgery on both the physical and the physiological well-being of young adults. Statistical analysis of the scoring of the individual questions and the total score of individual patients revealed a statistically significant improvement ( p < 0.05) following surgery. The SSQ had a highly significant correlation to the NQ-mA questionnaire (correlation coefficient = 0.682, p = 0.001). Overall, the SSQ revealed a statistically significant improvement ( p = 0.001) in self-esteem and a high level of satisfaction following the Nuss procedure. Only two patients fell into a low satisfaction group. Conclusion: The Nuss procedure has already been shown to have a positive impact on both the physical and psychosocial well-being of children who are suffering from pectus excavatum deformity. We have shown a similar positive impact in young male adults, in the short term. #
European Journal of Cardio-Thoracic Surgery, 2011
The aim of this study was to evaluate the effects of anterior chest-wall deformities on disease-specific and health-related quality of life, body image, and psychiatric comorbidity prior to surgical correction. Methods: A total of 90 patients (71 with pectus excavatum, 19 with pectus carinatum) presenting themselves for pectus repair and 82 control subjects were recruited for this study. The objective severity of the deformity was determined through the funnel-chest index by Hümmer and the Haller index. Disease-specific quality of life was measured with the Nuss Questionnaire modified for Adults (NQ-mA) and health-related quality of life was determined by the Short-Form-36 Health Survey (SF-36). Body image was assessed via the Body Image Questionnaire (FKB-20), the Dysmorphic Concern Questionnaire (DCQ), and a self-evaluation of the subjective impairment of the appearance. The Diagnostic Interview for Mental Disorders-Short Version (Mini-DIPS), the General Depression Scale (Allgemeine Depressionsskala, ADS), and a self-rating of self-esteem were used to evaluate general psychological impairment. Results: Compared with control group results, physical quality of life was reduced in patients with pectus excavatum, while mental quality of life was decreased in patients with pectus carinatum (p < 0.05). Body image was highly disturbed in all the patients and differed significantly from the control group (p < 0.01). Patients with pectus carinatum appeared to be less satisfied with their appearance than those with pectus excavatum (p = 0.07). Body image distress was multivariately associated with both reduced mental quality of life and low self-esteem (p < 0.001). Body image did not influence physical quality of life. Patients displayed no elevated rates of mental disorders according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. Conclusion: Since self-perception is a major contributor to therapeutic decision making, a systematic evaluation of body image should be included in the assessment of patients with chest deformities. Body image concerns may be even more relevant to the decision-making process than physical restrictions. Exaggerated dysmorphic concerns should be prospectively investigated in their ability to influence the extent of satisfaction with the surgical outcome.
Minimally invasive repair of pectus excavatum deformity
European Journal of Cardio-thoracic Surgery, 2011
This review is trying to address the effectiveness and sustainability of results following minimally invasive repair of pectus excavatum (MIRPE). The aim is to present these results for the benefit of clinicians and the patients. Literature search has revealed 179 hits, which were independently assessed and led to 80 publications being formally reviewed. Studies reporting results from less than 10 patients were excluded. Thirty-five studies were found to be reporting results from patients' and/or surgeons' perspective and they were included in this review. Data from the United Kingdom registry for MIRPE were also included. Results from over 2997 patients (age: <1-85 years) who had MIRPE and 1393 patients who had their metallic bar removed were assessed. The most common indication for surgery was cosmesis. There was a net gain with regard to self-esteem for 96-100% of the individuals. A percentage of procedures (0-20%) was assessed by surgeons as having an 'unsatisfactory outcome' and a number of patients (0-25%) reported an 'unsatisfactory end result.' However, these percentages are not necessarily referring to the same patients and an unsatisfactory result does not seem to affect the positive effect on self-esteem. The reported changes in social life, lung capacity, cardiovascular capacity, exercise capacity and general health are based on weak data and significant improvements, if any, are probably seen in a limited number of patients. The metallic bars were removed after 1.5-4.5 years and there is an overall 0-4.5% reported recurrence post-bar removal. In conclusion, MIRPE may improve cosmesis and self-esteem of patients with pectus excavatum deformity. Direct or indirect improvement in other physiological parameters may also help the 'well-being' of these patients and their social integration. There is a clear need for standardisation in the way results are reported in the literature and a socioeconomic analysis with regard to gains, benefits and costs related to MIRPE.
Early Consequences of Pectus Excavatum Surgery on Self-Esteem and General Quality of Life
World Journal of Surgery
Background An early observation after chest wall correction is direct inspection from the PE patient of their ''new'' thorax. Changes in self-perception may give raise to other psychological adaptations. The aim of this study was to evaluate the early changes in the fields of self-esteem, body image and QoL. Methods Prospective observational longitudinal multicenter cohort study. Self-esteem, emotional limitations and general health were assessed using the Child Health Questionnaire (CHQ) in patients under 18 and the World Health Organization Quality of Life Questionnaire-bref (WHOQOL-bref) was used for body image, psychological domain and overall QoL in patients over 16 years of age. Measurements were taken before surgery (T1) and 6 weeks (T2), and 6 months thereafter (T3). Results Scores on post-operative self-esteem were significantly higher compared with scores pre-operatively (p \ 0.007). Also body image, psychological domain and emotional limitations showed significant improvement, respectively p \ 0.001, p \ 0.001, and p \ 0.016. Significant improvement in the first three components was mainly achieved in the first 6 weeks post-operative. In emotional limitation, however, the largest change was between 6 weeks and 6 months. Overall quality of life in the WHOQOL-bref and general health domain in the CHQ showed no significant improvement in relation to the pre-operative scores. Conclusion Post-operative PE patients after Nuss procedure showed an improved body image, increased self-esteem and increased psychological resilience in the first 6 months, with the most marked change in the first 6 weeks. Also emotional limitations changed significantly over time. The changes were not large enough to influence general QoL or general health significantly.
Psychosocial functioning in pediatric patients with pectus excavatum and pectus carinatum
TURKISH JOURNAL OF MEDICAL SCIENCES, 2017
Background/aim: Pectus excavatum and pectus carinatum are the most commonly seen anterior chest wall deformities. Recent studies reveal that minimal invasive repair of pectus deformities improves the quality of life. Our aim is to assess the psychosocial functioning and sociodemographic characteristics of pediatric patients with pectus deformities and evaluate the differences between patients operated on with minimal invasive repair techniques and nonoperated patients. Materials and methods: Thirty-two patients with pectus deformities who were operated on 6 months or more before and 31 nonoperated patients participated in the study. The Children's Depression Inventory, Piers-Harris Children's Self-Concept Scale, Capa Social Phobia Scale for Children and Adolescents, Strengths and Difficulties Questionnaire-Self-Report Version (SDQ-SR), and State-Trait Anxiety Inventory for Children-Trait Version were completed by the patients. The SDQ-Parent Report Version (SDQ-PR) was completed by their parents. Results: There were no statistically significant differences between operated and nonoperated patient groups in terms of total scores on the psychiatric rating scales. Prosocial behavior subscale scores in SDQ-SR (P = 0.013) and SDQ-PR (P = 0.019) were lower in the operated group. Conclusion: Prosocial behavior levels were lower in the operated group. Further exploration of the psychosocial profile of pediatric patients with pectus deformities would better elucidate their needs in the course of their socioemotional development.