Bracing for Success: Long-term Patient-reported Outcomes of Bracing Therapy for Pectus Carinatum.

INTRODUCTION

Pectus carinatum (PC) is typically managed by compressive bracing therapy during adolescence. This study assesses the long-term patient-reported outcomes of bracing therapy on adolescents diagnosed with PC.

MATERIALS AND

METHODS

We identified 867 patients diagnosed with PC and treated at our institution between 2013 and 2023. Patients and/or guardians were contacted via email and phone to complete a survey. The 17-question survey evaluated self-reported brace usage, cosmetic satisfaction, and quality of life outcomes.

RESULTS

Ninety-eight patients completed the survey; 81.6% were male, and 65.3% identified as not Hispanic or Latino. The mean age at initial clinic visit was 12.5 y (SD = 3.5). Bracing therapy was recommended for 70 (71.4%) respondents, and 51 (72.9%) proceeded with bracing therapy. Among those who underwent bracing, 7 (13.7%) patients had scoliosis and 6 (11.8%) had connective tissue disorders, including Marfan syndrome (n = 2), Ehlers-Danlos syndrome (n = 2), and kyphosis (n = 2). The mean daily wear time was 8.7 h (SD = 3.37), worn on average 6.39 d per week (SD = 1.24). Thirty-five patients (71.4% of 49 respondents) reported improvement in their chest wall appearance following bracing therapy. These patients braced for a significantly longer duration (mean = 25.2 mo, SD = 22.5) than those that saw no improvement in their chest wall appearance (mean = 10.2 mo, SD = 8.0; t = 3.28, P = 0.002). Twelve (23% of 42 respondents) patients reported a return of their PC after ending bracing therapy. Neither the number of hours worn per day nor the number of days worn per week was a statistically significant predictor of patient-reported improvement. Complications or negative effects during bracing were reported by 16 (31.4%) patients, including discomfort (n = 7, 44%), pain (n = 4, 25.0%), bruising/scarring (n = 3, 18.8%), irritation of gastrostomy tube site (n = 1, 6.2%), and poor self-esteem when bracing (n = 1, 6.2%).

CONCLUSIONS

Bracing therapy remains an effective treatment option for patients with PC. Overall, 23% reported their deformity returned after discontinuing bracing, and nearly one-third of patients reported negative effects from bracing therapy. Patients who reported an improvement in PC continued bracing treatment for a longer duration. Further studies need to be conducted to improve prolonged compliance and mitigate quality-of-life impacts in adolescents undergoing bracing therapy for PC.