Sherif Emil1, Marika Sévigny2, Kathleen Montpetit3, Robert Baird2, Jean-Martin Laberge2, Jade Goyette3, Ian Finlay3, Guylaine Courchesne3. 1. Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada. Electronic address: Sherif.Emil@McGill.ca. 2. Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada. 3. Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada.
Abstract
BACKGROUND: This study sought to establish factors that can prognosticate outcomes of bracing for pectus carinatum (PC). METHODS: Prospective data were collected on all patients enrolled in a dynamic bracing protocol from July 2011 to July 2015. Pressure of correction (POC) was measured at initiation of treatment, and pressure of treatment (POT) was measured pre- and post-adjustment at every follow-up visit. Univariate and Cox regression analysis tested the following possible determinants of success and bracing duration: age, sex, symmetry, POC, and POT drop during the first two follow-up visits. RESULTS: Of 114 patients, 64 (56%) succeeded, 33 (29%) were still in active bracing, and 17 (15%) failed or were lost to follow-up. In successful patients, active and maintenance bracing was 5.66±3.81 and 8.80±3.94months, respectively. Asymmetry and older age were significantly associated with failure. Multivariable Cox proportional hazard analysis of time-to-maintenance showed that asymmetry (p=0.01) and smaller first drop in POT (p=0.02) were associated with longer time to reach maintenance. CONCLUSIONS: Pressure of correction does not predict failure of bracing, but older age, asymmetry, and smaller first drop in pressure of treatment are associated with failure and longer bracing duration. LEVEL OF EVIDENCE: Prospective Study/Level of Evidence IV.
BACKGROUND: This study sought to establish factors that can prognosticate outcomes of bracing for pectus carinatum (PC). METHODS: Prospective data were collected on all patients enrolled in a dynamic bracing protocol from July 2011 to July 2015. Pressure of correction (POC) was measured at initiation of treatment, and pressure of treatment (POT) was measured pre- and post-adjustment at every follow-up visit. Univariate and Cox regression analysis tested the following possible determinants of success and bracing duration: age, sex, symmetry, POC, and POT drop during the first two follow-up visits. RESULTS: Of 114 patients, 64 (56%) succeeded, 33 (29%) were still in active bracing, and 17 (15%) failed or were lost to follow-up. In successful patients, active and maintenance bracing was 5.66±3.81 and 8.80±3.94months, respectively. Asymmetry and older age were significantly associated with failure. Multivariable Cox proportional hazard analysis of time-to-maintenance showed that asymmetry (p=0.01) and smaller first drop in POT (p=0.02) were associated with longer time to reach maintenance. CONCLUSIONS: Pressure of correction does not predict failure of bracing, but older age, asymmetry, and smaller first drop in pressure of treatment are associated with failure and longer bracing duration. LEVEL OF EVIDENCE: Prospective Study/Level of Evidence IV.