ArticleJournal of thoracic disease2024
Defining the optimal annual institutional case volume for minimally invasive repair of pectus excavatum through a systematic review of literature and meta-analysis of outcomes.
Article in Journal of thoracic disease, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Valve-sparing Aortic Root Replacement: Defining High-volume Centres Using Prospective Data.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026Article
- Extension of the minimally invasive pectus repair to adult patients: strategies for success.Journal of thoracic disease · 2026Review
- Reproducibility and Consistency of Methods to Define Hospital-Level Procedural Volume Thresholds for Pancreatectomy.Journal of surgical oncology · 2026Article
- Diagnosis and Management of Pectus Excavatum in Primary Care.Journal of the American Board of Family Medicine : JABFM · 2026Article
- Pectus excavatum revision surgery: a complex challenge requiring centralization of expertise.Journal of thoracic disease · 2025Article
- The optimal annual case volume for acute type A aortic dissection surgery in relation to long-term outcomes.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025Article
- Surgical Treatment of Pectus Excavatum: The Boundary Between Pathologic and Aesthetic Need.Journal of clinical medicine · 2025Article
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Authors and funding
8 authors.
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Abstract
Background: The Nuss procedure is the accepted standard approach to correct pectus excavatum. Still, is associated with potential major complications that are in part believed to be preventable as they might be the consequence of institutional case-volume differences. The objective is to evaluate the presence of a volume-outcome relation for the Nuss procedure and determine the optimal annual institutional case-volume threshold, defining high-volume centers. Methods: A systematic literature search was performed, considering studies from unique centers reporting on pectus excavatum patients who underwent the Nuss procedure. Primary and secondary outcomes were, respectively: the incidence of significant perioperative complications (Clavien-Dindo ≥ grade-III and significant intraoperative complications) and bar displacement. The presence of a non-linear volume-outcome relation was evaluated through restricted-cubic-spline-analyses. If present, the optimal annual institutional case-volume was determined by the elbow method. Results: Forty-nine studies from 49 unique centers were included, enrolling 13,352 patients in total. The significant perioperative complication rate was low [7.7%, 95% confidence interval (CI): 6.4-9.0%] and demonstrated a significant non-linear volume-outcome relation (P<0.001), even after covariate adjustment. The optimal annual institutional case-volume was determined at 73 cases/year (95% CI: 67-89). In this scenario, the number needed to treat to prevent a single perioperative complication compared to a low volume center was 11 (95% CI: 8-19). A similar volume-outcome relation (P<0.001) and optimal case volume of 73 cases/year was observed for bar displacement. Conclusions: A significant volume-outcome relation for repair of pectus excavatum by the Nuss procedure exists with an optimal annual institutional case-volume of 73 cases/year. These findings provide rationale for centralization.
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