Clinical results of enhanced recovery after surgery in children after pectus excavatum repair


  • M.O. Ovdii Bogomolets National Medical University, Kyiv, Ukraine
  • S.P. Kryvopustov Bogomolets National Medical University, Kyiv, Ukraine
  • G.V. Saltykova Bogomolets National Medical University, Kyiv, Ukraine
  • V.D. Pismennyi Bogomolets National Medical University, Kyiv, Ukraine
  • N.S. Boyko Bogomolets National Medical University, Kyiv, Ukraine
  • V.V. Lomaka National Children’s Specialized Hospital «OKHMATDYT», Kyiv, Ukraine
  • L.G. Kopyl National Children’s Specialized Hospital «OKHMATDYT», Kyiv, Ukraine



children, enhanced recovery, chest deformity, Nuss procedure, pediatrics


The funnel-shaped deformity of the chest is the most common defect of the chest, which can cause cosmetic problems, but also a decrease in tolerance to physical activity, cause fatigue, shortness of breath and chest pain.

The application of the enhanced recovery protocol and rehabilitation interventions after Nuss procedure are poorly described in the literature.

Purpose - to evaluate the clinical results of using a modified protocol of enhanced recovery after surgical correction of pectus excavatum in children.

Materials and methods. The results of the treatment of 79 patients with a funnel-shaped chest deformity aged (14.2±1.6) who underwent surgical correction of the deformity according to Nuss method were analyzed. Two groups of patients were analyzed, according to the protocol of postoperative management: the Group I (n=20) - patients of traditional postoperative management, the Group II (n=59) - according to the the enhanced protocol of recovery. In the Group II, psychological and physical training was additionally included in the preoperative plan.

Results. The groups were the same in terms of age, Haller index, and time of surgery (p>0.05). The length of stay in the hospital was significantly (p<0.001) shorter in patients of the Group II. The use of the epidural analgesia method in patients of the Group II made it possible to significantly reduce both the dose and the duration of taking opioid analgesics to 1 day, in contrast to the Group I (up to 3 days). The lack of pleural drainage enabled the patient to become more active after a day - to get up, walk, and take some procedures.

Conclusions. The protocol of the enhanced postoperative recovery, which includes a program of rehabilitation treatment, early removal of the urinary catheter and early verticalization of the patient, improves the quality of recovery of patients after reconstruction of funnel-shaped deformity of the chest and reduces the length of stay of patients in hospital treatment after surgery.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the participating institution. Informed consent of the patients was obtained for the research.

No conflict of interests was declared by the authors.


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