Introduction
Pectus excavatum is a relatively common congenital chest wall deformity. It causes a sunken breastbone (sternum) and ribs, which can not only affect the physical appearance but also, in severe cases, lead to cardiopulmonary impairment and physiologic limitations. In New York City, there are several public hospitals with a good reputation for treating mild pectus excavatum. This article will provide a comprehensive review of these hospitals, including their rankings, specialties, and treatment capabilities.
Understanding Pectus Excavatum
Definition and Prevalence
Pectus excavatum is a congenital (present at birth) deformity of the front of the chest wall that causes a sunken breastbone (sternum) and ribs. It is also called funnel or sunken chest. It occurs in approximately one in every 700 births (personal communication, March of Dimes Birth Defects Foundation, March 1995), and men are afflicted 5 times more often than women. The condition is uncommon among African Americans and Latinos. The cause of pectus excavatum remains unknown, but approximately 40% of patients with pectus deformities have family members who also have deformities, although a direct genetic link has not been identified. Disturbances in the growth of the sternum and costal arches, as well as biomechanical factors, are suspected in the pathogenesis.
Symptoms and Complications
Some of the common symptoms and associated issues include:
- Appearance: The most obvious sign is the sunken appearance of the chest. In young patients, this is often the most common complaint as it can cause self - esteem issues, especially during adolescence.
- Exercise Limitation: Many patients experience mild to severe exercise limitation with decreased stamina and endurance. They may find it difficult to keep up with their peers in strenuous athletic activities, especially those older than 6 years, and the problem is most severe in those older than 16 years. Some had been able to participate in competitive athletic activities during early adolescence but then gradually find it more difficult.
- Respiratory Problems: Approximately 32% of patients have frequent respiratory infections, and 7% have asthmatic symptoms, which are often severe after exercise.
- Chest Pain: Some patients, especially older ones, may experience aching or compression - type pain in the lower anterior chest after exercise, and in some cases, pain may even occur at rest.
- Cardiac Issues: Although most cases of mild pectus excavatum may not cause significant cardiac problems, severe cases can lead to cardiac compression and affect heart function. About 24% of patients have functional heart murmurs, and 13 patients out of 375 in a study had cardiac anomalies.
Evaluating Hospitals for Pectus Excavatum Treatment
Criteria for Selection
When looking for a hospital to treat mild pectus excavatum, several factors should be considered:
- Medical Reputation: Hospitals with a good national or regional ranking often have a team of experienced doctors and advanced medical facilities. For example, a hospital that is nationally ranked in relevant specialties is more likely to have in - depth research and rich clinical experience in treating pectus excavatum.
- Specialty Expertise: The hospital should have specialists in pediatric or thoracic surgery, as pectus excavatum is mainly treated through surgical means. These specialists should be familiar with different surgical techniques for pectus excavatum repair, such as the open surgery and the minimally invasive Nuss procedure.
- Patient Experience: This includes factors like the friendliness of the staff, the comfort of the hospital environment, and the overall patient - centered care approach. A positive patient experience can greatly contribute to the patient's recovery process.
- Research and Innovation: Hospitals actively involved in research on pectus excavatum are more likely to adopt the latest treatment methods and provide better - personalized treatment plans. For example, using advanced diagnostic tools or improving surgical techniques to reduce complications.
- Success Rate and Complications: A hospital with a high success rate and low complication rate in pectus excavatum repair is a more reliable choice. This can be evaluated through patient reviews and medical reports.
Review of New York City Public Hospitals for Pectus Excavatum
New York - Presbyterian Hospital - Columbia and Cornell
- Ranking and Reputation: This hospital is highly regarded in New York City. It is nationally ranked in 14 adult specialties and 10 pediatric specialties, and #1 in New York, NY. It is also ranked amongst the top 5 in the US. It is a large non - profit hospital and the largest non - sectarian hospital in the US. With over 2,455 + beds for patients, over 6000 associated physicians, and over 19000 employees, it receives more than 2 million patient visits yearly, accounting for over 10% of the population of NYS.
- Specialty Expertise: It has a comprehensive medical team that can provide multidisciplinary care. For pectus excavatum treatment, its thoracic surgeons may offer a variety of surgical options, including the minimally invasive Nuss procedure. The hospital also has experience in handling complex cases related to chest wall deformities due to its high - level of medical research and clinical practice.
- Patient Experience: The hospital is well - equipped and has a range of advanced technologies, such as an MRI - guided linear accelerator (the MRIdian by ViewRay), nuclear medicine, EOS machine, the Dilumen, CT scan, and high - quality PET scan. This not only helps in accurate diagnosis but also provides better treatment results. The large number of experienced medical staff can ensure that patients receive timely and comprehensive care. Moreover, as a teaching hospital of two world - class medical schools (Columbia University Medical Center and Weill Cornell Medical Center), it can attract top - notch medical talents, which is beneficial for patient treatment and follow - up care.
NYU Langone Hospitals
- Ranking and Reputation: It is #2 hospital in the NYC and ranked amongst the top ten in the US. Nationally ranked in 13 adult specialties and 3 pediatric specialties, it also receives about 37000 patients annually and is high - performing in 21 procedures.
- Specialty Expertise: NYU Langone contains the Laura and Isaac Perlmutter Cancer Center with top - rated oncology specialists and provides academic medical training for New York University medical students. Its surgical team may be well - versed in the latest surgical techniques for pectus excavatum. For example, they can use minimally invasive surgical approaches, which can lead to less pain, less blood loss, and a quicker recovery for patients.
- Patient Experience: The main facility, Tisch Hospital in Manhattan, is the teaching hospital of NYU School of Medicine. Hassenfeld Children’s Hospital, part of NYU Langone, is newly established and has a child - friendly environment with many child - friendly sculptures at its entrance. It also has a bed capacity of just over 100 with a wide variety of pediatric professionals. Each patient room has a user - friendly touch screen device known as “My Wall” which provides easy access to information and entertainment. The hospital also utilizes telemedicine to enhance patient care, allowing patients to access health care providers before a hospital visit.
Mount Sinai Hospital
- Ranking and Reputation: It is #3 hospital in NYC. It is nationally ranked in 12 adult specialties and 4 pediatric specialties and high - performing in 20 procedures/conditions. It is one of the oldest and biggest facilities in the US. There are over 7000 physicians in the Mount Sinai Health System, with a bed capacity of over 300. It was ranked 14th in the United States by the US News and World Record and received recognition from AHA highlights for top - quality treatment for stroke, heart failure, and heart attack.
- Specialty Expertise: The hospital has newly established systems that ensure patients have a variety of clinical care specialties and treatments. Its medical team has extensive experience in thoracic surgery. For pectus excavatum, they can offer both open and minimally invasive surgical options. Over the years, the hospital has shown innovation in medical procedures, such as performing the first - ever successful composite tracheal transplant in 2005 and the first transplant of blood into the vein of a fetus as far back as 1986.
- Patient Experience: The hospital has implemented various technology - based medical interventions and updated biomedical imaging techniques, such as digital health tools, machine learning to device improved treatment, AI and digital usage in the study of pathology, and Dose Net for treatment of cancer. This can help in more accurate diagnosis and better - personalized treatment. The health care professionals at this facility have a good reputation for taking exceptional care of their patients.
North Shore University Hospital at Northwell Health
- Ranking and Reputation: It is #4 in New York City and nationally ranked in 9 adult specialties. It is high - performing in 15 procedures/conditions. It is a part of Northwell Health and is well - known for its specialized skills in neurosciences and has introduced dedicated research centers all over NYC.
- Specialty Expertise: The hospital has a strong medical team in thoracic surgery. Although the focus may not be solely on pectus excavatum, its overall surgical experience and resources can be beneficial for treating patients with chest wall deformities. The hospital has expertise in various medical specialties such as cancer, cardiac and heart surgery, pulmonary and lung surgery, etc., which can provide comprehensive support in the treatment process of pectus excavatum, especially if there are associated complications.
- Patient Experience: Although it has a relatively smaller number of bed spaces (838 - bed spaces currently), it makes up for it with the quality of its staff, friendly reception, and comfortable surroundings. The hospital emphasizes patient - centered care, which can contribute to a better patient experience during the treatment and recovery period.
Lenox Hill Hospital at Northwell Health
- Ranking and Reputation: It is #5 in New York City and nationally ranked in 10 specialties. It is high - performing in 1 specialty and 16 procedures/conditions. As part of Northwell Health, it benefits from the overall medical resources and reputation of the health system.
- Specialty Expertise: The hospital has a team of medical professionals with experience in different surgical fields. In the context of pectus excavatum, they may be able to offer appropriate surgical and non - surgical treatment options based on the patient's condition. Their comprehensive medical services can cover pre - operative evaluation, surgical treatment, and post - operative rehabilitation.
- Patient Experience: Lenox Hill Hospital focuses on providing a comfortable and patient - friendly environment. The staff is trained to provide high - quality care, and the hospital may offer support services such as patient education, counseling, and follow - up care to ensure a smooth recovery process for patients with pectus excavatum.
Treatment Options for Pectus Excavatum in These Hospitals
Open Surgery
Open surgery is a traditional method for pectus excavatum repair. The surgeon makes a cut (incision) across the front part of the chest. The deformed cartilage is removed, leaving the rib lining in place to allow the cartilage to grow back correctly. A cut is then made in the breastbone, which is moved to the correct location. A metal strut (support piece) may be used to hold the breastbone in the normal position until it heals, which takes 3 to 12 months. The surgeon may place a tube to drain fluids that build up in the area of repair. At the end of surgery, the incision is closed. The metal struts are removed in 6 to 12 months through a small cut in the skin under the arm, usually on an outpatient basis. Most of the above - mentioned hospitals, given their surgical expertise, are capable of performing open surgery for pectus excavatum.
Minimally Invasive Surgery (Nuss Procedure)
The Nuss procedure is a relatively new, minimally invasive alternative to open surgery. The surgeon makes two small incisions, one on each side of the chest. A small video camera called a thoracoscope is placed through one of the incisions to view inside the chest. A curved steel bar shaped to fit the child is inserted through the incisions and placed under the breastbone to lift it. The bar is left in place for at least 2 years to help the breastbone grow properly. This procedure usually has a shorter operative time (53 minutes on average in one study compared to 143 minutes for open surgery), less blood loss (0.5 ml/kg compared to 6 ml/kg in open surgery), and a similar postoperative hospitalization time (3.7 days compared to 3.2 days for open surgery). New York - Presbyterian Queens, for example, offers the minimally invasive Nuss procedure for pectus excavatum, and other hospitals with advanced surgical capabilities may also provide this option.
Recovery and Follow - Up
Immediate Post - operative Recovery
After pectus excavatum surgery, it is common for children to stay in the hospital for 3 to 7 days. Pain is common after the surgery. For the first few days, patients may receive strong pain medicine in the vein (through an IV) or through a catheter placed in the spine (an epidural). After that, pain is usually managed with medicines taken by mouth. Patients may have tubes in the chest around the surgical cuts to drain extra fluid, which are removed when they stop draining, usually after a few days. The day after surgery, patients are encouraged to sit up, take deep breaths, and get out of bed and walk to aid in healing. At first, patients will not be able to bend, twist, or roll from side to side, and activities will be slowly increased.
Long - term Follow - Up
Long - term follow - up is crucial to ensure the proper healing and development of the chest wall. Patients will need regular check - ups to monitor the position of the breastbone, the growth of the cartilage, and the overall function of the heart and lungs. In most cases, the surgery leads to improvements in appearance, breathing, and the ability to exercise. However, there is a small risk of complications such as the return of the deformity, hypertrophic scar formation, or other issues related to the surgical site. These potential problems need to be monitored during the follow - up visits. All the reviewed hospitals should be able to provide comprehensive long - term follow - up care, including physical examinations, imaging studies (such as X - rays or CT scans), and cardiac and pulmonary function tests if necessary.
Conclusion
In New York City, there are several public hospitals with a good reputation for treating mild pectus excavatum. New York - Presbyterian Hospital - Columbia and Cornell, NYU Langone Hospitals, Mount Sinai Hospital, North Shore University Hospital at Northwell Health, and Lenox Hill Hospital at Northwell Health all have their own advantages in terms of ranking, specialty expertise, and patient experience. When choosing a hospital for pectus excavatum treatment, patients and their families should consider the specific needs of the patient, the hospital's reputation, and the treatment options available. With proper treatment and follow - up, most patients with mild pectus excavatum can achieve significant improvements in both physical appearance and overall quality of life.
If you or someone you know is dealing with mild pectus excavatum, we encourage you to further research these hospitals, consult with their medical staff, and make an informed decision about the best treatment option. Share this article with others who may find it helpful in their search for the right hospital for pectus excavatum treatment.
