Pectus Excavatum: A Multimodal Pathway for Patients Undergoing the Nuss Procedure

Abstract

Pectus excavatum is a chest wall deformity affecting 1 in 400–1,000 births. There are two surgical correction techniques to repair this chest wall deformity; the Ravitch procedure and the Nuss procedure. Pain issues after the Nuss procedure are potentially more significant than those after the open repair, although minimally invasive. The pain issues have significant impacts on the capacity for deep breathing, early mobilization/ambulation, opioid consumption, and length of hospital stay. CHOP has developed an enhanced multimodal pathway for patients undergoing the procedure. The work group included general surgeons, anesthesiologists, APNs, RNs, physical therapists, and psychologists as well as project and process managers. The goal is to standardize the care of the postoperative pain management, thereby resulting in a decreased length of stay and a 10% decrease in pain scores over a 3-month period.