Age-related outcomes of minimally invasive repair of pectus excavatum: a single-center retrospective cohort study

Background: Pectus excavatum (PE) is the most common congenital deformity of the anterior chest wall. Although minimally invasive repair of pectus excavatum (MIRPE) is widely accepted as the standard surgical approach, the relationship between patient age and postoperative safety remains incompletely defined. This study aimed to examine age-related differences in postoperative effectiveness and complication profiles following MIRPE. Methods: This retrospective cohort study included 719 patients with congenital PE who underwent complete correction using the MIRPE at a single University Medical Center over 8 years. The patients were stratified according to age at surgery as follows: 2-5, 6-11, 12-15, 16-18, and >18 years. Effectiveness was assessed based on clinical improvement, body mass index (BMI), and Haller index (HI), whereas safety was evaluated based on postoperative complication rates. Multivariate logistic regression was performed to estimate adjusted odds ratios (aORs) and confidence intervals (CIs). Results: Mean age of the 719 patients was 12.4±5.7 years. All age groups demonstrated comparable postoperative improvements in clinical status, BMI, and HI (P>0.05). However, complication rates increased with age: 7.6% (2-5 years group), 11.8% (6-11 years group), 15.2% (12-15 years group), 18.1% (16-18 years group), and 21.6% (>18 years group) (P=0.02). Compared with the 2-5 years group, the aOR for each complication was 1.45 (95% CI: 0.63-3.56, P=0.40) for the 6-11 years group, 2.02 (95% CI: 0.93-4.75, P=0.09) for the 12-15 years group, 2.38 (95% CI: 1.09-5.66, P=0.04) for the 16-18 years group, and 3.07 (95% CI: 1.31-7.65, P=0.01) for the >18 years group. Conclusions: Although MIRPE was effective across all age groups, younger patients experienced lower complication rates in this retrospective cohort. These findings should be interpreted as observational and hypothesis-generating rather than prescriptive. Prospective studies and randomized controlled trials remain essential to define evidence-based age recommendations for surgical repair of PE.