Pectus excavatum, often referred to as sunken chest syndrome, is a common chest wall disorder, particularly among children and adolescents. For 13 - year - olds in New York City dealing with this condition, finding the right hospital for surgery is of utmost importance. This article will delve into various aspects related to pectus excavatum surgery and provide an analysis of some of the top hospital institutions in New York City for this specific procedure.
Understanding Pectus Excavatum
Pectus excavatum occurs when the breastbone is sunken inward, leaving a dent in the chest. This condition can be visible shortly after birth or become more prominent around puberty, as stated by CHOC’s pectus treatment program. It affects approximately one out of 1,000 children, with boys being about five times more likely to be affected than girls, according to Nationwide Children's Hospital. Children with pectus excavatum may experience symptoms such as chest pain, shortness of breath (especially during exertion), mitral valve prolapse, and associated skeletal growth syndromes or scoliosis.
Diagnosis of Pectus Excavatum
Diagnosing pectus excavatum can be done through several methods. Doctors commonly use chest x - rays (both front and side views) or a chest CT scan. The severity of the deformity can often be assessed with just x - rays using measurements like the pectus severity index or haller index. Additionally, pulmonary function tests may be conducted to check how well the lungs are working, and an echocardiogram (an ultrasound of the heart) can be used to assess the heart's function and structure, as mentioned in UCLA Health's information on pectus excavatum and carinatum repair.
When is Surgery Recommended?
Surgery is typically recommended for moderate to severe pectus deformities, especially if the haller index (a measurement of the chest’s shape) is greater than 3.2. For reference, a normal haller index is around 2.5. Surgery may also be considered if the patient has symptoms related to their condition, such as those affecting the heart and lung function. The best age to get the Nuss procedure (a common surgical method for pectus excavatum) is between 13 – 16 years old when the chest’s cartilage and bones are still malleable and easier to manipulate and bend into the correct shape, as stated by the Center of Excellence for Pectus.
Surgical Procedures for Pectus Excavatum
There are two main surgical procedures for correcting pectus excavatum: the Ravitch procedure and the Nuss procedure.
Ravitch Procedure
The Ravitch procedure is a well - established surgical method. An incision is made across the chest, just below the nipples. The deformed cartilage is removed, and the sternum is gently adjusted and repositioned. A supportive bar is placed to help hold everything in the correct position as it heals. The recovery period includes a hospital stay of 3 to 5 days, and the stabilizing bar is usually removed after about 6 months when new cartilage has formed to support the sternum and ribs, as described in UCLA Health's details on pectus excavatum repair.
Nuss Procedure
The Nuss procedure is a newer and more popular method for correcting pectus excavatum. Two small cuts, each about 1 inch long, are made on either side of the rib cage. A curved, titanium bar is carefully placed through these cuts and positioned under the sternum. A small camera is used to protect the organs inside the chest, and cryoablation of the nerves is performed to relax the chest for remodeling with minimal pain. The bar is rotated to press against the chest wall, pushing the ribs and sternum outward. Cartilage or bone is usually not removed during this procedure, and the bar stays in place for 2 to 3 years to reshape the chest. The Nuss procedure is quicker than the Ravitch procedure, leads to less blood loss, smaller incisions, and minimal scarring, with a usual hospital stay of 1 to 2 days. The bar is removed in a brief outpatient procedure once the chest has fully healed, according to UCLA Health.
Hospital Institutions in New York City for Pectus Excavatum Surgery
New York - Presbyterian / Columbia University Irving Medical Center
New York - Presbyterian / Columbia University Irving Medical Center is a top - ranked hospital. It was named the top hospital in New York and made the honor roll as no. 7 in the nation by U.S. News & World Report’s Best Hospitals. The institution is recognized for its excellence in 14 adult specialties and 8 children’s specialties. In terms of surgical excellence, it has nationally - ranked adult surgical specialties such as heart surgery, gi surgery, and lung surgery, as well as children’s specialties including pediatric heart surgery, pediatric gi surgery, and pediatric lung surgery. While there is no specific mention of pectus excavatum surgery in the provided sources, its overall high - quality surgical care and research environment suggest that it could offer advanced treatment options for pectus excavatum cases.
Mount Sinai Hospital
At Mount Sinai, the team of surgeons has joined forces to diagnose and manage chest wall conditions, including pectus excavatum. The doctors work with world - class colleagues in pediatric and adult cardiology, pulmonology, genetics, orthopedic surgery, radiology, anesthesiology, and orthopedics. They also collaborate with interventionists and physical therapists to provide the latest treatment methods and surgical innovations for the best possible result. The hospital conducts research to develop more effective treatments and explore ways to prevent or improve chest wall conditions. For example, they have already developed specialized instrumentation for chest wall surgery, which improves the process and outcomes, as stated on their official website.
Valley Hospital (in association with The Center of Excellence for Pectus)
The Center of Excellence for Pectus, associated with Valley Hospital, is a premier center for the Nuss procedure to treat pectus excavatum. Dr. Barry Losasso, affiliated with this center, has been treating pectus excavatum and pectus carinatum for teens and adults since 1999. He trained with Dr. Donald Nuss, the founder of the Nuss procedure, and has performed over 1,400 successful Nuss procedures. The center is also one of the only centers to perform chest wall reconstruction on children and adults ages 10 - 55 years old. Patients who undergo the Nuss procedure at Valley Hospital can expect an excellent pain management team to monitor pain closely following the surgery, with multiple pain management modalities being utilized to ensure a successful and uneventful recovery.
Factors to Consider When Choosing a Hospital for Pectus Excavatum Surgery
When choosing a hospital for pectus excavatum surgery for a 13 - year - old in New York City, several factors should be taken into account:
Expertise of Surgeons
The experience and expertise of the surgeons are crucial. Surgeons like Dr. Barry Losasso at The Center of Excellence for Pectus, who have extensive experience in performing the Nuss procedure and have trained with the founder of the technique, can offer higher - quality surgical outcomes. Their knowledge of the latest surgical advancements and their ability to handle potential complications are essential for a successful surgery.
Multidisciplinary Team
A hospital with a multidisciplinary team is beneficial. For example, Mount Sinai's approach of having surgeons work with colleagues in various specialties such as cardiology, pulmonology, and genetics ensures comprehensive care. A 13 - year - old with pectus excavatum may have associated conditions or require pre - and post - operative evaluation and treatment from different specialists. A well - coordinated multidisciplinary team can provide personalized treatment plans and better overall care.
Research and Innovation
Hospitals that are involved in research and innovation, like Mount Sinai and New York - Presbyterian / Columbia University Irving Medical Center, are more likely to offer the latest treatment options and surgical techniques. Research can lead to the development of better instrumentation, improved pain management strategies, and enhanced surgical outcomes for pectus excavatum patients.
Patient Experience and Support
The patient experience and support provided by the hospital are also important. This includes aspects such as the pain management team at Valley Hospital, which helps patients have a more comfortable recovery. Additionally, support services like the pectus family mentorship program at CHOC, which connects past pectus patients with new patients to assist families through the process, can be valuable for the psychological well - being of the 13 - year - old patient and their family during the treatment journey.
Comparison of Hospital Institutions
| Hospital | Expertise in Pectus Excavatum Surgery | Multidisciplinary Team | Research and Innovation | Patient Experience and Support |
|---|---|---|---|---|
| New York - Presbyterian / Columbia University Irving Medical Center | High - ranked in multiple surgical specialties, may have advanced surgical expertise, but no specific mention of pectus excavatum. | Has a wide range of specialties working together, potential for comprehensive care. | Engaged in research and has a history of innovation in surgical care. | As a top - ranked hospital, likely to provide good patient experience, but no specific pectus - related support mentioned. |
| Mount Sinai Hospital | Team focused on chest wall conditions, including pectus excavatum. | Surgeons work with multiple specialties for comprehensive diagnosis and treatment. | Conducts research on chest wall conditions and has developed specialized instrumentation. | Strives to understand patient hopes and goals, providing individualized care. |
| Valley Hospital (associated with The Center of Excellence for Pectus) | Premier center for the Nuss procedure, surgeon with over 1,400 successful procedures. | Potential collaboration with other specialists as part of normal hospital services. | No specific mention of research, but likely benefits from overall medical knowledge. | Excellent pain management team for patient recovery. |
Outcomes and Considerations for 13 - Year - Olds
According to a study on national trends in pectus excavatum repair, adolescent patients (12 - 17 years old) have different characteristics compared to older age groups. In the study of patients undergoing the modified Nuss procedure, adolescent patients had a lower rate of complications compared to adults. For example, the rate of any postoperative complication for 12 - 17 - year - olds was 30.6%, while for patients over 30 years old, it was 62.1%. This indicates that 13 - year - olds may have a relatively better prognosis in terms of surgical outcomes, especially when the surgery is performed at a high - quality hospital with experienced surgeons.
Another important aspect is the financial cost. The study also showed that the median total charges for 12 - 17 - year - olds undergoing the modified Nuss procedure were $57,312, which is lower than the charges for patients over 30 years old ($67,014). However, it's important to note that insurance coverage can vary significantly, and families should consult with the hospital's financial department and their insurance provider to understand the out - of - pocket costs.
Conclusion
In conclusion, for 13 - year - olds in New York City requiring pectus excavatum surgery, institutions like New York - Presbyterian / Columbia University Irving Medical Center, Mount Sinai Hospital, and Valley Hospital (associated with The Center of Excellence for Pectus) are all strong contenders. Each hospital has its own strengths, whether it's overall surgical excellence, a dedicated chest wall team, or extensive experience in a specific surgical procedure. Parents and guardians should carefully consider factors such as the expertise of surgeons, the availability of a multidisciplinary team, research and innovation in the field, and the patient experience and support when making a decision.
If you have a 13 - year - old dealing with pectus excavatum, we encourage you to reach out to these hospitals for consultations. You can gather more information about their treatment options, surgical procedures, and patient outcomes. Share this article with other families who may be in a similar situation to help them make an informed decision about their child's pectus excavatum surgery.
