Risk of serious perioperative complications with removal of double bars following the Nuss procedure.
Objectives
The aim of this study is to present our experience with Nuss bar removal and evaluate potential risk factors. The Nuss procedure requires an operation to remove the bar 2-3 years after the initial correction. Although removal of the bar is generally believed to be safe, perioperative complications including major bleeding can occur.


Methods
All cases involving removal of the Nuss bar done since April 2007 were recorded in a prospective database. Data were collected on the amount of blood loss, the number of diagnostic interventions, operative management and postoperative course.


Results
Of a total of 246 (162 with single bars, 80 with double bars, 4 with triple bars) cases, 43 patients (17.5%) experienced perioperative complications. Five patients underwent secondary postoperative interventions; one patient required same-session emergency video-assisted thoracic surgery (VATS) due to major bleeding. Patients who had complications were significantly older than patients with no complications (20.5 ± 6.5 years vs 17.2 ± 5.9 years, P = 0.002). People having double bars removed were significantly more likely to have perioperative complications (12% vs 27%, P = 0.03) and complications requiring secondary interventions (n = 1 for a single bar, n = 5 for double bars, P = 0.01).


Conclusions
Major complications after removal of the Nuss bar occur with some frequency. Although the double-bar removals in our cohort were associated with major complications, the reasons are poorly understood. Immediate management of the complications may require multidisciplinary care. Multicentric pooling of cases is needed for better risk stratification.
['Bilgi|Zeynep|Z|', 'Ermerak|Nezih Onur|NO|', 'Çetinkaya|Çagatay|Ç|', 'Laçin|Tunç|T|', 'Yüksel|Mustafa|M|']
D000293:Adolescent D002648:Child D016208:Databases, Factual D020878:Device Removal D005260:Female D005660:Funnel Chest D006801:Humans D007431:Intraoperative Complications D008297:Male D011183:Postoperative Complications D012189:Retrospective Studies D012307:Risk Factors D020775:Thoracic Surgery, Video-Assisted D055815:Young Adult
Bar removal Nuss operation Pectus excavatum