Pectus excavatum is a common chest wall deformity where the sternum appears sunken into the chest. This condition can range in severity, causing physical symptoms or affecting self-image. The Nuss procedure is a surgical option designed to correct this indentation, offering a minimally invasive way to reshape the chest wall. While generally effective, like any surgery, it involves inherent risks.
Understanding the Nuss Procedure
During the Nuss procedure, small incisions are made on each side of the chest. A custom metal bar is inserted through these incisions and passed underneath the sternum. The bar is then rotated, pushing the sternum outward to correct the deformity.
The bar remains in place for approximately two to four years, allowing the chest wall to remodel into its corrected position. After this period, a second, simpler outpatient procedure removes the bar. This technique avoids large incisions and extensive cartilage removal associated with older open surgical methods.
Reported Death Rates and Their Nuances
Official reports cite very low death rates for the Nuss procedure, less than 0.05% or even 0.01%. However, these rates may be higher in reality due to underreporting and a lack of comprehensive global data. Anecdotal evidence and surgeon interviews suggest that deaths related to the Nuss procedure are not as rare as published literature indicates. This discrepancy can arise from reporting biases, as adverse outcomes may not always be formally documented or shared.
The true incidence of mortality is not fully known because the total number of procedures performed worldwide is not precisely tracked. A review identified 12 reported cardiac injuries with four deaths, and uncovered 15 additional unreported cases with five more deaths through surveys and malpractice reviews. This suggests that a portion of serious outcomes may go unrecorded in standard medical literature.
Major Complications and Contributing Factors
The most severe complication is injury to the heart or major vessels. These injuries can occur during the bar’s insertion or, less commonly, its removal. For instance, a heart injury can happen if the introducer tool or the bar itself accidentally perforates or lacerates the heart or surrounding large blood vessels. Such an injury can lead to massive bleeding and can be fatal if not immediately addressed.
Several factors can increase the risk of these major complications. A surgeon’s experience plays a significant role, with higher risk during the procedure’s learning curve. The severity and rigidity of the pectus excavatum deformity can also increase the surgical challenge and risk of complications. Patients with previous cardiac surgeries may also face an elevated risk of cardiac injury during the Nuss procedure.
Other Potential Complications and Recovery
Beyond the most severe risks, other complications, while generally not fatal, can still impact recovery. These include bar displacement, where the bar shifts out of position, occurring in about 4.5% of cases. Pneumothorax (collapsed lung) and pleural effusion (fluid around the lung) are also possible, with incidences around 2.7% and 2.5%, respectively. Surgical site infections are rare (less than 1%) but can occur and may require antibiotic treatment. Chronic pain is another issue, reported in about 2.2% of patients.
Recovery from the Nuss procedure involves a hospital stay of three to five days, primarily for pain management. Patients receive continuous pain medication, such as an epidural catheter, when pain is most intense. After discharge, oral painkillers are prescribed, with stronger medications gradually reduced over several weeks. Physical activity restrictions are advised for six to twelve weeks to prevent bar displacement, though light activities like walking and deep breathing are encouraged early in recovery. Full return to normal physical activities, including sports, can take up to three months.