Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence

Detalhes bibliográficos
Autor(a) principal: Araújo,Maria Elizete de Almeida
Data de Publicação: 2014
Outros Autores: Penha,Anderson da Paz, Westphal,Fernando Luiz, Silva,Marcus Tolentino, Galvão,Taís Freire
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista do Colégio Brasileiro de Cirurgiões
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912014000600400
Resumo: Objective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.
id CBC-1_10b10bc69e5da562b09b001b109d3516
oai_identifier_str oai:scielo:S0100-69912014000600400
network_acronym_str CBC-1
network_name_str Revista do Colégio Brasileiro de Cirurgiões
repository_id_str
spelling Nuss procedure for Pectus excavatum repair: critical appraisal of the evidenceFunnel chestEvidence-based medicineEffectivenessSurgical procedures, operativeObjective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.Colégio Brasileiro de Cirurgiões2014-12-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912014000600400Revista do Colégio Brasileiro de Cirurgiões v.41 n.6 2014reponame:Revista do Colégio Brasileiro de Cirurgiõesinstname:Colégio Brasileiro de Cirurgiões (CBC)instacron:CBC10.1590/0100-69912014006004info:eu-repo/semantics/openAccessAraújo,Maria Elizete de AlmeidaPenha,Anderson da PazWestphal,Fernando LuizSilva,Marcus TolentinoGalvão,Taís Freireeng2015-09-25T00:00:00Zoai:scielo:S0100-69912014000600400Revistahttp://www.scielo.br/rcbcONGhttps://old.scielo.br/oai/scielo-oai.php||revistacbc@cbc.org.br1809-45460100-6991opendoar:2015-09-25T00:00Revista do Colégio Brasileiro de Cirurgiões - Colégio Brasileiro de Cirurgiões (CBC)false
dc.title.none.fl_str_mv Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence
title Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence
spellingShingle Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence
Araújo,Maria Elizete de Almeida
Funnel chest
Evidence-based medicine
Effectiveness
Surgical procedures, operative
title_short Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence
title_full Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence
title_fullStr Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence
title_full_unstemmed Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence
title_sort Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence
author Araújo,Maria Elizete de Almeida
author_facet Araújo,Maria Elizete de Almeida
Penha,Anderson da Paz
Westphal,Fernando Luiz
Silva,Marcus Tolentino
Galvão,Taís Freire
author_role author
author2 Penha,Anderson da Paz
Westphal,Fernando Luiz
Silva,Marcus Tolentino
Galvão,Taís Freire
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Araújo,Maria Elizete de Almeida
Penha,Anderson da Paz
Westphal,Fernando Luiz
Silva,Marcus Tolentino
Galvão,Taís Freire
dc.subject.por.fl_str_mv Funnel chest
Evidence-based medicine
Effectiveness
Surgical procedures, operative
topic Funnel chest
Evidence-based medicine
Effectiveness
Surgical procedures, operative
description Objective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.
publishDate 2014
dc.date.none.fl_str_mv 2014-12-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912014000600400
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912014000600400
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1590/0100-69912014006004
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/html
dc.publisher.none.fl_str_mv Colégio Brasileiro de Cirurgiões
publisher.none.fl_str_mv Colégio Brasileiro de Cirurgiões
dc.source.none.fl_str_mv Revista do Colégio Brasileiro de Cirurgiões v.41 n.6 2014
reponame:Revista do Colégio Brasileiro de Cirurgiões
instname:Colégio Brasileiro de Cirurgiões (CBC)
instacron:CBC
instname_str Colégio Brasileiro de Cirurgiões (CBC)
instacron_str CBC
institution CBC
reponame_str Revista do Colégio Brasileiro de Cirurgiões
collection Revista do Colégio Brasileiro de Cirurgiões
repository.name.fl_str_mv Revista do Colégio Brasileiro de Cirurgiões - Colégio Brasileiro de Cirurgiões (CBC)
repository.mail.fl_str_mv ||revistacbc@cbc.org.br
_version_ 1754209212746956800