F-030OUTCOMES FOLLOWING REVISION PECTUS EXCAVATUM REPAIR IN THE ADULT
Bibliographic record
Abstract
Objectives: Surgical repair of pectus excavatum is generally undertaken before adolescence in order to avoid ossification and possible worsening of the defect which occurs with puberty. However, an unsatisfactory result can occur either primarily or as a result of pubertal changes, requiring revision surgery in adult life. We review the outcomes of revision pectus surgery at two adult centres with experience in both Nuss and Ravitch procedures for pectus repair. Methods: Retrospective data on revision pectus surgery were collected at two adult centres over a period from 2005 to 2014. Variables collected included demographics, operative details and outcomes from the first and second operation, and satisfaction following the revision operation. Using our pectus repair database, a 1:1 cohort of sex, age, and procedure matched patients who underwent an index pectus operation was generated as a control. Results: Approximately 350 pectus operations were performed at the two centres over the study period. Seventeen were revisions. Indication for reoperation was recurrence in 13 (76%) and resultant asymmetrical pectus carinatum in 4 (24%). Median age at first operation was 15 (4-33) and re-operation was 20 (14-35). Median time between operations was 7 years (1-23). The initial operation was Ravitch in 11 (65%) and Nuss in 6 (35%). Six (35%) patients underwent the Ravitch after the Nuss procedure and 11 (65%) patients had the Nuss after the Ravitch procedure. Significant adhesions were encountered in 3 (18%) patients, all Nuss after Ravitch. Complications included Nuss bar migration (6%), chest wall hematoma (6%), persistent pain (6%) and wound infection (6%). Sixteen (94%) patients were satisfied with the final outcome. When compared to the control cohort, median length of stay (P = 0.94) and complication rate (P = .99) were similar. Conclusions: Revision pectus excavatum surgery in the adult is safe and effective. A Nuss procedure can be revised with a Ravitch and vice-versa. Therefore, chest wall reconstructive surgeons need to be experienced with all surgical techniques to comprehensively manage patients with index or recurrent pectus excavatum. Disclosure: No significant relationships.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".