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Pectus Excavatum: The Kansas City Experience

Pectus Excavatum: The Kansas City Experience. George W. Holcomb, III, M.D., M.B.A . Surgeon-in-Chief Children’s Mercy Hospital Kansas City, MO. Pectus Excavatum Jan 1998 – August 2011. 520 Nuss Operations Surgeons: Ashcraft, Sharp, Ostlie, Snyder, St. Peter, Holcomb.

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Pectus Excavatum: The Kansas City Experience

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  1. Pectus Excavatum:The Kansas City Experience George W. Holcomb, III, M.D., M.B.A. Surgeon-in-Chief Children’s Mercy Hospital Kansas City, MO

  2. Pectus ExcavatumJan 1998 – August 2011 • 520 Nuss Operations • Surgeons: Ashcraft, Sharp, Ostlie, Snyder, St. Peter, Holcomb

  3. The Kansas City Experience • Major variation in technique is the use of a sub-xiphoid incision for insertion of a finger to guide the bar passer and bar across the mediastinum.

  4. The Kansas City Experience Please use this link if you experience problems viewing the video above.

  5. The Kansas City Experience • 520 Patients • No cardiac injuries using the subxiphoid incision • I.V. narcotics (PCA) preferred over epidural catheter for postoperative pain control

  6. The Kansas City ExperienceDecember ‘99 – March ‘09 • 307 Pts • Mean age 14 yrs – 78% males • Mean O.R. time – 50 ±16 minutes • Two bars – 16 (5%) • Mean length hospitalization 4.1 ± 1.1 days • Mean time bar removal 33 ± 7 months J PediatrSurg 45:1361-1364, 2010

  7. The Kansas City Experience307 Patients J PediatrSurg 45:1361-1364, 2010

  8. The Kansas City ExperienceRetrospective Study On Pain ManagementJan 2000 – Feb 2006 • 203 Pts • 188 epidural • 15 I.V. narcotics (PCA) • Epidural removed w/in 24 hours in 65 pts (34.5%) J PediatrSurg 43:79-82, 2008

  9. The Kansas City Experience Retrospective Study On Pain Management J PediatrSurg 43:79-82, 2008

  10. The Kansas City Experience Prospective Randomized Trial On Pain ManagementSept 2006 – May 2010 • Epidural catheter vs I.V. narcotics (PCA) • Power 0.80; α 0.05 • 110 Pts (55 each arm) • Epidural removed w/in 24 hrs – 12 pts (22%) • PCA required after epidural removal in 7 patients (16%) APSA 2011 Accepted, J PediatrSurg

  11. The Kansas City Experience Operation Times – Epidural vs PCA

  12. The Kansas City ExperienceHospital Charges – Epidural vs PCA

  13. QUESTIONS www.cmhpectus.com www.cmhmis.com

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