Introduction

Pectus excavatum is a congenital deformity of the chest wall that can cause physical and psychological problems for patients. For 13 - year - olds in New York City facing this condition, finding a suitable regular hospital for surgery is of utmost importance. In this article, we will explore the top - ranking regular hospitals for pectus excavatum surgery at this age in New York City, and also cover various aspects related to the condition, surgery, and hospital selection.

Understanding Pectus Excavatum

What is Pectus Excavatum?

Pectus excavatum is the most common anterior chest wall deformity, occurring in about 1 in 300 - 400 live births each year. It is characterized by a sunken breastbone (sternum) and ribs, sometimes also called funnel or sunken chest. The condition may worsen during the teen years, especially during puberty. In most cases, it is an isolated finding, but in some instances, it can be associated with genetic conditions.

Causes and Symptoms

The exact cause of pectus excavatum is unknown, but often the tendency to develop it runs in families. Young children with pectus excavatum usually have no symptoms. However, as the child grows, especially during puberty, the malformation becomes more pronounced. Teenagers may experience shortness of breath with exertion, pain at the front of the chest, and early fatigue. In severe cases, it can shift the heart to the left side of the chest and compress the lungs, limiting the child's ability to take deep breaths.

Diagnosis

Doctors commonly use chest x - rays (both front and side views) or a chest CT scan to evaluate pectus excavatum. To reduce radiation exposure, the severity of the deformity can often be assessed with just x - rays using measurements like the pectus severity index or haller index. The haller index compares the depth of the chest cavity beneath the sternum to the width of the chest cavity (from right to left). A normal ratio of width - to - depth is about 2.5 to 1, and any calculation greater than 3.25 is considered a moderate to severe defect (as per research from the Johns Hopkins Children's Center).

Surgery for Pectus Excavatum

Types of Surgeries

There are two main types of surgeries for pectus excavatum repair: open surgery and closed (minimally invasive) surgery.

• Open Surgery: This is the more traditional approach. The surgeon makes a cut across the front part of the chest, removes the deformed cartilage while leaving the rib lining in place to allow for proper cartilage regrowth. A cut is made in the breastbone, which is then moved to the correct location and may be held in place with a metal strut until it heals (which takes 3 to 12 months). A tube may be placed to drain fluids, and the metal struts are removed in 6 to 12 months through a small cut under the arm, usually on an outpatient basis.
• Minimally Invasive Surgery (Nuss Procedure): This method is mostly used for children. The surgeon makes two small incisions on each side of the chest, inserts a thoracoscope through one of the incisions to view inside the chest, and then places a curved steel bar shaped to fit the child under the breastbone. The bar is left in place for at least 2 years to help the breastbone grow properly. The scope is removed at the end of the surgery, and the incisions are closed. Cryoablation may be used to reduce pain after surgery by freezing the nerves above and below the bar on each side of the chest for three months. The bars are removed later as an outpatient procedure.

Best Age for Surgery

The best age to get the nuss procedure, which is a common minimally invasive surgery for pectus excavatum, is between 13 – 16 years old. At this age, the chest's cartilage and bones are still malleable and easier to manipulate and bend into the correct shape. However, surgeries can also be successfully performed on younger children (usually not before age 6) and adults in their early 20s.

Risks Associated with Surgery

General risks for anesthesia and surgery include reactions to medicines, breathing problems, bleeding, blood clots, or infection. Specific risks for pectus excavatum surgery are injury to the heart, lung collapse, pain, and the return of the deformity.

Criteria for Ranking Hospitals

When ranking regular hospitals for pectus excavatum surgery at the age of 13 in New York City, several key criteria are considered:

• Surgeon Experience: The experience of the surgeons performing the pectus excavatum surgeries is crucial. Surgeons who have performed a large number of these procedures are more likely to have better skills and knowledge to handle any complications that may arise during the surgery. For example, a surgeon who has trained with the founders of surgical techniques like the Nuss procedure may bring a higher level of expertise.
• Success Rate: The success rate of the pectus excavatum surgeries in terms of improving the appearance of the chest wall, enhancing breathing ability, and reducing post - operative complications is an important factor. A high success rate indicates the quality of the surgical team and the hospital's overall approach to patient care.
• Research and Innovation: Hospitals that are involved in research related to pectus excavatum, such as improving surgical techniques or understanding the causes and long - term effects of the condition, are often better equipped to provide the latest and most effective treatments. They may also have access to new technologies and approaches that can benefit young patients.
• Patient Care: This includes pre - operative evaluations, pain management during and after the surgery, and post - operative follow - up care. A hospital with a dedicated pediatric team that can provide personalized care and support to 13 - year - old patients and their families is highly desirable. The presence of a pain management team, for instance, can ensure that the child has a more comfortable recovery.
• Reputation: The overall reputation of the hospital in the medical community and among patients is also a significant consideration. Hospitals that are nationally ranked or have received awards for their surgical specialties are often more likely to provide high - quality care for pectus excavatum surgery.

Ranking of Regular Hospitals in New York City for Pectus Excavatum Surgery at Age 13

1. Columbia University Irving Medical Center (New York - Presbyterian / Columbia)

This hospital is ranked very highly. It was named the top hospital in New York and rose to No. 4 in the nation by U.S. News & World Report’s Best Hospitals. It ranks nationally in 15 adult specialties and 8 pediatric specialties. In the field of surgical excellence, its US News & World nationally - ranked surgical specialties related to relevant areas include adult heart surgery, GI surgery, lung surgery, and in the children's specialties, pediatric heart surgery, pediatric GI surgery, and pediatric lung surgery. These surgical specialties show that the hospital has a comprehensive and high - level surgical department, which is very important for pectus excavatum surgery as it may involve related thoracic and abdominal organs. Moreover, a hospital with such a high - ranking status is likely to have experienced surgeons, advanced medical equipment, and a strong research and innovation environment to provide high - quality treatment for 13 - year - old patients with pectus excavatum.

2. NYU Langone Hospitals

NYU Langone Hospitals is also a top - notch institution. It is nationally ranked in 13 adult specialties and 3 pediatric specialties and is high - performing in 1 specialty and 20 procedures/conditions. The hospital has a team of doctors dedicated to providing the most advanced, personalized care for pectus excavatum patients. With its well - rounded medical expertise and focus on patient - centered care, it can offer a suitable environment for 13 - year - olds undergoing pectus excavatum surgery. Their doctors can use the latest treatment methods and technologies to ensure the best possible outcome for the young patients.

3. Mount Sinai Hospital

Mount Sinai Hospital is ranked among the best in New York. It is nationally ranked in 12 adult specialties and 4 pediatric specialties and high - performing in 20 procedures/conditions. Mount Sinai provides comprehensive information on pectus excavatum repair, including details about the two types of surgeries (open and minimally invasive), pre - operative preparations, and post - operative care. This shows that the hospital has in - depth knowledge and experience in handling pectus excavatum cases. The hospital's ability to address all aspects of the surgical process is beneficial for 13 - year - old patients and their families as they can receive a full range of care and support.

4. The Center of Excellence for Pectus

Established in 2005, the Center of Excellence for Pectus is a premier center for the Nuss procedure to treat pectus excavatum. Dr. Barry Losasso, who has been treating pectus excavatum and pectus carinatum for teens and adults since 1999, trained with Dr. Donald Nuss, the founder of the Nuss procedure. He has performed over 1,400 minimally invasive Nuss procedures on adolescents and adults aged 10 - 55 years old. The center is one of the only centers to perform chest wall reconstruction on children and adults in this age range. With such a high volume of successful surgeries and a doctor with extensive experience, it is a great option for 13 - year - olds in New York City seeking pectus excavatum surgery.

Comparative Analysis of the Ranked Hospitals

Pre - operative and Post - operative Considerations

Pre - operative Considerations

Before the pectus excavatum surgery, a complete medical exam and medical tests are necessary. The surgeon will typically order an electrocardiogram (ECG) and possibly an echocardiogram to show how the heart is functioning, pulmonary function tests to check for breathing problems, and a CT scan or MRI of the chest. Parents should tell the surgeon or nurse about any medicines their child is taking (including drugs, herbs, vitamins, or supplements), and any allergies the child may have to medicine, latex, tape, or skin cleanser. About 7 days before surgery, the child may be asked to stop taking aspirin, ibuprofen, naproxen, warfarin, and other blood - thinning drugs. On the day of surgery, the child should not drink or eat anything after midnight the night before and should take any prescribed drugs with a small sip of water as instructed. It is also important to arrive at the hospital on time.

Post - operative Considerations

After the surgery, it is common for 13 - year - old patients to stay in the hospital for 3 to 7 days, depending on the recovery progress. Pain is common after the surgery, and in the first few days, the child may receive strong pain medicine through an IV or an epidural. Later, pain is usually managed with oral medicines. The child may have tubes in the chest around the surgical cuts to drain extra fluid, which will be removed when they stop draining, usually after a few days. The day after surgery, the child will be encouraged to sit up, take deep breaths, and get out of bed and walk to aid in healing. At first, activities such as bending, twisting, or rolling from side to side should be restricted, and activities will gradually be increased. Before leaving the hospital, parents will receive a prescription for pain medicine for their child, and they should follow any instructions for caring for the child at home.

Conclusion

For 13 - year - olds in New York City with pectus excavatum, choosing the right hospital for surgery is a crucial decision. Hospitals like Columbia University Irving Medical Center, NYU Langone Hospitals, Mount Sinai Hospital, and The Center of Excellence for Pectus offer different but high - quality options in terms of surgeon experience, success rates, patient care, and specialty expertise. Each hospital has its own unique strengths, and families should carefully consider these factors in consultation with their doctors to make an informed choice. Remember to weigh the pre - operative and post - operative requirements as well to ensure a smooth surgical experience and a successful recovery for the young patient.

If you or someone you know is facing pectus excavatum at the age of 13 in New York City, don't hesitate to reach out to these top - ranked hospitals. Research further, schedule consultations, and gather as much information as possible to make the best decision for the patient's health and well - being. Share this article with others who may find it helpful in their search for the right pectus excavatum surgery hospital.