Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence
Objective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were cla...
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| Format: | Article |
| Language: | English |
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Colégio Brasileiro de Cirurgiões
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| Series: | Revista do Colégio Brasileiro de Cirurgiões |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912014000600400&lng=en&tlng=en |
| _version_ | 1818969482859642880 |
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| author | Maria Elizete de Almeida Araújo Anderson da Paz Penha Fernando Luiz Westphal Marcus Tolentino Silva Taís Freire Galvão |
| author_facet | Maria Elizete de Almeida Araújo Anderson da Paz Penha Fernando Luiz Westphal Marcus Tolentino Silva Taís Freire Galvão |
| author_sort | Maria Elizete de Almeida Araújo |
| collection | DOAJ |
| description | Objective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team. |
| first_indexed | 2024-12-20T14:21:18Z |
| format | Article |
| id | doaj.art-76cf1bb955224a64b9f8de4dfb19ded0 |
| institution | Directory Open Access Journal |
| issn | 1809-4546 |
| language | English |
| last_indexed | 2024-12-20T14:21:18Z |
| publisher | Colégio Brasileiro de Cirurgiões |
| record_format | Article |
| series | Revista do Colégio Brasileiro de Cirurgiões |
| spelling | doaj.art-76cf1bb955224a64b9f8de4dfb19ded02022-12-21T19:37:55ZengColégio Brasileiro de CirurgiõesRevista do Colégio Brasileiro de Cirurgiões1809-454641640040510.1590/0100-69912014006004S0100-69912014000600400Nuss procedure for Pectus excavatum repair: critical appraisal of the evidenceMaria Elizete de Almeida AraújoAnderson da Paz PenhaFernando Luiz WestphalMarcus Tolentino SilvaTaís Freire GalvãoObjective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912014000600400&lng=en&tlng=enFunnel chestEvidence-based medicineEffectivenessSurgical procedures, operative |
| spellingShingle | Maria Elizete de Almeida Araújo Anderson da Paz Penha Fernando Luiz Westphal Marcus Tolentino Silva Taís Freire Galvão Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence Revista do Colégio Brasileiro de Cirurgiões Funnel chest Evidence-based medicine Effectiveness Surgical procedures, operative |
| title | Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence |
| title_full | Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence |
| title_fullStr | Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence |
| title_full_unstemmed | Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence |
| title_short | Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence |
| title_sort | nuss procedure for pectus excavatum repair critical appraisal of the evidence |
| topic | Funnel chest Evidence-based medicine Effectiveness Surgical procedures, operative |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912014000600400&lng=en&tlng=en |
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