Effects of NUSS surgery on degree of flat thoracic cage, cardiopulmonary function, and bone metabolism in pectus excavatum patients of different ages

This study was to explore the degree of flat thoracic cage (FTC), cardiopulmonary function, and bone metabolism of pectus excavatum (PE) children of different ages after NUSS surgery. A retrospective analysis was conducted on 90 children with PE who underwent minimally invasive pectus excavatum correction surgery (NUSS), divided into three age groups: group I (1-3 years), group II (3-6 years), and group III (6-12 years), with 30 patients in each group. The study compared differences in thoracic flattening index, surgical-related metrics, pulmonary function, peripheral blood levels of alkaline phosphatase (ALP), calcium, magnesium, zinc, and phosphorus, and complication rates among the groups. Preoperative ALP level increased with aging of the children (P < 0.05). After surgery, the FTC index and ALP level of all the three groups greatly decreased, but increased with aging (P < 0.05). The operating time, intraoperative blood loss, and postoperative duration of analgesia also showed a trend of group III > group II > group I (P < 0.05). Postoperative levels of pulmonary function, including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), maximum expiratory flow at 75% of vital capacity (MEF75), maximum expiratory flow at 50% of vital capacity (MEF50), maximum expiratory flow at 25% of vital capacity (MEF25), and maximal mid-expiratory flow (MMEF), were significantly higher than preoperative levels in group I (P < 0.05); but without significant changes in groups II and III (P > 0.05). Neglectable differences were found in peripheral blood Ca, Mg, Zn, and P levels before and after surgery and postoperative complications in three groups (P > 0.05). The degree of FTC worsened with aging; the younger the children receiving NUSS surgery are, the more obvious the improvement of postoperative PF.