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Войти в исследования Journal of pediatric surgery · 2026
Comparison of coaxial double-bar and other bar configurations during pectus bar removal in a single center: Retrospective single center study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Shih Beatrice Chia-Hui, Moon Duk Hwan, Lee Sungsoo
Аннотация
BACKGROUND: Pectus bar removal following minimally invasive repair of pectus excavatum (MIRPE) is often considered a minor procedure, but operative difficulty can vary substantially due to fibrotic adhesion and osseous formation at the bar-chest wall interface. The influence of bar configuration on these factors remains insufficiently evaluated.
METHOD: A retrospective cohort study was conducted in patients under 20 years old who underwent elective pectus bar removal between January 2024 and February 2026 in our institution. Patients were categorized into coaxial double bar and non-double bar configurations. Primary outcomes included operative time, estimated blood loos (EBL), and intraoperative evidence of bony invasion or formation. Propensity score matching was performed using two approaches: (1) matching for age at bar removal and bar dwelling duration, and (2) matching for age at removal alone. Multivariable logistic regression was used to assess independent associations between bar configuration and removal-related outcomes.
RESULTS: A total of 315 patients were analyzed; 109 coaxial double bar and 206 non-double bar. In the unmatched cohort, double bar configuration was associated with shorter operative time (30.09 vs. 53.96 minutes, P<0.001), lower EBL (6.86 vs. 28.4 mL, P=0.018), and reduced bony reaction (23.9% vs. 56.3%, P<0.001). After propensity score matching for age at removal alone, double-bar configuration remained associated with shorter operative time, lower EBL, and lower rates of bony reaction. After additional matching for bar dwelling duration, operative time and EBL remained significantly lower in the coaxial double-bar group, whereas differences in bony reaction were attenuated and no longer statistically significant. On multivariable analysis, coaxial double-bar configuration was independently associated with lower odds of bony reaction (OR 0.25; 95% CI, 0.14-0.47), high EBL (OR 0.36; 95% CI, 0.16-0.81), and prolonged operative time (OR 0.08; 95% CI, 0.04-0.17) (all P<0.05).
CONCLUSION: Coaxial double-bar configuration is associated with reduced osseous reaction and more favorable intraoperative outcomes during pectus bar removal. These findings suggest that load distribution across multiple bars may mitigate periosteal stimulation and facilitate safer and less complex removal. Consideration of bar configuration at the time of MIRPE may influence both corrective and removal phases.
METHOD: A retrospective cohort study was conducted in patients under 20 years old who underwent elective pectus bar removal between January 2024 and February 2026 in our institution. Patients were categorized into coaxial double bar and non-double bar configurations. Primary outcomes included operative time, estimated blood loos (EBL), and intraoperative evidence of bony invasion or formation. Propensity score matching was performed using two approaches: (1) matching for age at bar removal and bar dwelling duration, and (2) matching for age at removal alone. Multivariable logistic regression was used to assess independent associations between bar configuration and removal-related outcomes.
RESULTS: A total of 315 patients were analyzed; 109 coaxial double bar and 206 non-double bar. In the unmatched cohort, double bar configuration was associated with shorter operative time (30.09 vs. 53.96 minutes, P<0.001), lower EBL (6.86 vs. 28.4 mL, P=0.018), and reduced bony reaction (23.9% vs. 56.3%, P<0.001). After propensity score matching for age at removal alone, double-bar configuration remained associated with shorter operative time, lower EBL, and lower rates of bony reaction. After additional matching for bar dwelling duration, operative time and EBL remained significantly lower in the coaxial double-bar group, whereas differences in bony reaction were attenuated and no longer statistically significant. On multivariable analysis, coaxial double-bar configuration was independently associated with lower odds of bony reaction (OR 0.25; 95% CI, 0.14-0.47), high EBL (OR 0.36; 95% CI, 0.16-0.81), and prolonged operative time (OR 0.08; 95% CI, 0.04-0.17) (all P<0.05).
CONCLUSION: Coaxial double-bar configuration is associated with reduced osseous reaction and more favorable intraoperative outcomes during pectus bar removal. These findings suggest that load distribution across multiple bars may mitigate periosteal stimulation and facilitate safer and less complex removal. Consideration of bar configuration at the time of MIRPE may influence both corrective and removal phases.