Comparison of the Nuss versus Ravitch procedure for pectus excavatum repair: an updated meta-analysis

Background/purpose: To evaluate surgical outcomes of Nuss versus Ravitch repair of pectus excavatum via a systematic review and meta-analysis. Methods: Medline, PubMed, Cochrane, EMBASE, and Google Scholar databases were searched up to September 5, 2016 using the following search terms: pectus excavatum, funnel chest, Nuss; Ravitch, minimally invasive, and open surgery. Randomized controlled trials, two-arm prospective, and two-arm retrospective studies were eligible for inclusion. Results: Nineteen studies were included with a total of 1731 patients: 989 treated with Nuss and 742 treated with Ravitch. The overall analysis revealed that patients in the Nuss group had significantly shorter operation time (pooled SMD = -2.83, 95% CI = -3.76 to -1.90, p < 0.001) and less blood loss (pooled SMD = -1.68, 95% CI = -2.28 to -1.09, P < 0.001) than the Ravitch group. However, the length of hospital stay was similar between groups (pooled SMD = -0.55, 95% CI = -1.44 to 0.35, p = 0.230). These findings were similar in the subgroup analysis for randomized and non-randomized controlled studies. Complications were not assessed due to inconsistent reporting across the included studies. Conclusions: Our meta-analysis demonstrate that the Nuss procedure has a shorter operative time and less operative blood loss than the Ravitch procedure while the postoperative length of stay was similar. Levels of evidence: Level III. (C) 2017 Elsevier Inc. All rights reserved.