Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1218-1222 (doi:10.1542/peds.2007-2723)

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ARTICLE

Surgical Repair of Pectus Excavatum Markedly Improves Body Image and Perceived Ability for Physical Activity: Multicenter Study

Robert E. Kelly, Jr, MD^a,b, Thomas F. Cash, PhD^c, Robert C. Shamberger, MD^d, Karen K. Mitchell, RN^b, Robert B. Mellins, MD^e, M. Louise Lawson, PhD^b,f, Keith Oldham, MD^g, Richard G. Azizkhan, MD^h, Andre V. Hebra, MDⁱ, Donald Nuss, MBChB^a,b, Michael J. Goretsky, MD^a,b, Ronald J. Sharp, MD^j, George W. Holcomb, III, MD^j, Walton K. T. Shim, MD^k, Stephen M. Megison, MD^l, R. Lawrence Moss, MD^m, Annie H. Fecteau, MDⁿ, Paul M. Colombani, MD^o, Traci Bagley, RN, BSN^b, Amy Quinn, MS^b and Alan B. Moskowitz, MS^b

^a Departments of Surgery
^b Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia
^c Department of Psychology, Old Dominion University, Norfolk, Virginia
^d Department of Surgery, Harvard Medical School, Boston, Massachusetts
^e Department of Pediatrics, Columbia University, New York, New York
^f Department of Mathematics and Statistics, Kennesaw State University, Kennesaw, Georgia
^g Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
^h Department of Surgery, University of Cincinnati, Cincinnati, Ohio
ⁱ Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
^j Department of Surgery, University of Missouri at Kansas City, Kansas City, Missouri
^k Department of Surgery, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii
^l Department of Surgery, University of Texas Southwestern Medical School, Dallas, Texas
^m Department of Surgery, Yale University, New Haven, Connecticut
ⁿ Department of Surgery, University of Toronto, Toronto, Ontario, Canada
^o Department of Surgery, Johns Hopkins University, Baltimore, Maryland

OBJECTIVE. This study evaluated changes in both physical and psychosocial quality of life reported by the parent and child after surgical repair of pectus excavatum.

METHODS. As part of a multicenter study of pectus excavatum, a previously validated tool called the Pectus Excavatum Evaluation Questionnaire was administered by the research coordinator, via telephone, to parents and patients (8–21 years of age) before and 1 year after surgery. Eleven North American children's hospitals participated. From 2001 to 2006, 264 patients and 291 parents completed the initial questionnaire, and 247 patients and 274 parents completed the postoperative questionnaire. Responses used a Likert-type scale of 1 to 4, reflecting the extent or frequency of a particular experience, with higher values conveying less-desirable experience.

RESULTS. Preoperative psychosocial functioning was unrelated to objective pectus excavatum severity (computed tomographic index). Patients and their parents reported significant positive postoperative changes. Improvements occurred in both physical and psychosocial functioning, including less social self-consciousness and a more-favorable body image. For children, the body image component improved from 2.30 ± 0.62 (mean ± SD) to 1.40 ± 0.42 after surgery and the physical difficulties component improved from 2.11 ± 0.82 to 1.37 ± 0.44. For the parent questionnaire, the child's emotional difficulties improved from 1.81 ± 0.70 to 1.24 ± 0.36, social self-consciousness improved from 2.86 ± 1.03 to 1.33 ± 0.68, and physical difficulties improved from 2.14 ± 0.75 to 1.32 ± 0.39. Ninety-seven percent of patients thought that surgery improved how their chest looked.

CONCLUSIONS. Surgical repair of pectus excavatum can significantly improve the body image difficulties and limitations on physical activity experienced by patients. These results should prompt physicians to consider the physiologic and psychological implications of pectus excavatum just as they would any other physical deformity known to have such consequences.

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Key Words: pectus excavatum • Nuss procedure • open procedure • Ravitch procedure • outcomes research • comparative study • body image • exercise capacity • multicenter study • quality of life

Abbreviations: PE—pectus excavatum • PEEQ—Pectus Excavatum Evaluation Questionnaire

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Accepted Mar 3, 2008.

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