Quality of life with minimally invasive repair of pectus excavatum: a systematic review and meta-analysis

Jameelah Sheik Mohamed; Jian Wei Tan; John Kit Chung Tam

doi:10.21037/atm-23-1647

Quality of life with minimally invasive repair of pectus excavatum: a systematic review and meta-analysis

Ann Transl Med. 2023 Dec 20;11(12):407. doi: 10.21037/atm-23-1647. Epub 2023 Dec 6.

Authors

Jameelah Sheik Mohamed^#¹, Jian Wei Tan^#², John Kit Chung Tam^{1

2}

Affiliations

¹ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
² Department of Cardiac, Thoracic & Vascular Surgery, National University Heart Centre, Singapore, Singapore.

^# Contributed equally.

Abstract

Background: Minimally invasive repair of pectus excavatum (MIRPE) is a popular method for surgical correction of PE, and its impact on quality of life is a growing area of interest. We performed a systematic review and meta-analysis to evaluate the impact of MIRPE on the quality of life of patients.

Methods: This study was registered with PROSPERO under reference number CRD42020222061. A literature search of PubMed, Cochrane Library, EMBASE and Scopus was conducted from the date of inception till November 23, 2020. We included studies which administered one or more questionnaires on patients up to 60 years old, parents or both, to assess the quality of life before and after MIRPE. Studies not written in English, abstracts, articles without primary data, reviews and studies which combined data on PE and other deformities were excluded. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions and the Cochrane risk of bias tool. A random-effects meta-analysis was performed to obtain mean differences for key themes of quality of life before and after MIRPE. Responses from the same questionnaires, as well as common themes across different questionnaires, were compared.

Results: Of the 20 studies identified for systematic review, 7 studies that reported the responses of 478 patients were included in the meta-analysis. Patients who underwent MIRPE experienced an increased self-esteem [standardized mean difference (SMD): 1.38, 95% confidence interval (CI): 0.95 to 1.81, P<0.00001] and a smaller degree of chest interference with their social activities (SMD: 0.84, 95% CI: 0.60 to 1.08, P<0.00001). These findings were consistent even after the implanted bar was removed.

Conclusions: MIRPE may be associated with a better quality of life for patients with PE as self-esteem and extent of chest interference with social activities are improved after the procedure. The key limitations of this study are the lack of high-quality evidence due to paucity of randomized trials, and the significant heterogeneity in reported outcomes due to variations in the questionnaires and timepoints of administration.

Keywords: Pectus excavatum (PE); funnel chest; minimally invasive repair of pectus excavatum (MIRPE); quality of life.