The ranking of doctors and the charging standards for adolescent pectus excavatum correction in New York City are released!

Understanding Adolescent Pectus Excavatum

Pectus excavatum is the most common anterior chest wall deformity, occurring in about 1 in 300 - 1 in 400 live births. It is a congenital condition where the breastbone (sternum) appears sunken, and the chest has a concave shape. This condition may worsen during the teen years. In adolescent patients, pectus excavatum can have both physical and psychological impacts. Physically, it can cause shifting and compression of the heart, reduction in lung expansion, chest pain, breathing difficulties, fatigue, and reduced exercise tolerance. Psychologically, it can have profound psychosocial effects on affected adolescents due to body image concerns.

Prevalence and Risk Factors

The prevalence of pectus excavatum is relatively consistent across populations, with a higher occurrence in males. While the exact cause is unknown, it often runs in families, suggesting a genetic component. During adolescence, the overgrowth of rib cartilages before and after birth that causes the characteristic depression of the sternum commonly accelerates, leading to a more pronounced deformity. As noted in the research by Shale J. Mack et al., most patients with pectus excavatum in their study were male, with 79.2% of the full cohort being male. Also, in all age cohorts, patients were predominantly Caucasian, which might imply some ethnic - related prevalence trends.

Diagnosis of Adolescent Pectus Excavatum

Physical Examination

Doctors typically start with a physical examination of the chest. They look for the characteristic sunken appearance of the sternum and assess the degree of deformity. The doctor may also evaluate the patient's posture, as patients with pectus excavatum may have poor posture with slumped shoulders and a protruding abdomen.

Imaging Tests

• Chest X - rays: Front and side views of the chest can be used to get a basic understanding of the chest structure. However, they may not provide detailed information about the severity of the deformity.
• Chest CT Scan: This is a more accurate way to assess pectus excavatum. From a CT scan, the Haller index can be calculated. 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. Any calculation greater than 3.25 is considered a moderate to severe defect. As per the study by Patrick M. Poston et al., the Haller index remains the standard for determining candidacy for pectus excavatum repair in many cases, although there are suggestions that it may not accurately reflect pectus severity in patients with abnormal chest wall morphologies.

Other Tests

• Pulmonary Function Tests: These tests are used to check how well the lungs are working. In pectus excavatum patients, reduced lung function may be an indication of the impact of the deformity on the respiratory system.
• Echocardiogram: An ultrasound of the heart is used to assess its function and structure. Since pectus excavatum can cause shifting and compression of the heart, an echocardiogram can help detect any associated cardiac abnormalities.

Treatment Options for Adolescent Pectus Excavatum

Non - Surgical Treatment

• Observation: In mild cases of pectus excavatum, where there are no significant physical or psychological symptoms, doctors may choose to observe the patient over time. As the child grows, the deformity may not progress or may even improve slightly.
• Physical Therapy: Certain exercises can be prescribed to strengthen the chest and back muscles. This can help improve posture and potentially reduce the visual impact of the deformity. However, physical therapy alone is not a cure for pectus excavatum but can be used as a complementary treatment.

Surgical Treatment

• Ravitch Procedure:
  • Procedure Details: 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. As described in the UCLA Health source, Dr. Eric W. Fon Kalsrud improved this method to reduce the amount of cartilage removed, make it easier to reshape the chest wall, and achieve better results.
  • Recovery: The recovery period includes a hospital stay of 3 to 5 days. The stabilizing bar is usually removed after about 6 months, by which time new cartilage will have formed to help support the sternum and ribs.
• Nuss Procedure:
  • Procedure Details: 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 (breastbone). A small camera is used to allow the surgeons to see and protect the organs inside the chest. Cryoablation of the nerves is performed to relax the chest so it remodels and heals 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. The bar is secured with stitches and stays in place for 2 to 3 years to help reshape the chest. This technique was developed by Dr. Donald Nuss and has become very popular for treating pectus excavatum.
  • Recovery: The chest deformity is corrected right away. The Nuss procedure is usually quicker than the Ravitch procedure, leading to less blood loss, smaller incisions, and minimal scarring. The recovery time is faster than traditional methods, 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.

Doctor Ranking for Adolescent Pectus Excavatum Correction in New York City

Criteria for Ranking

• Experience: Doctors with more years of experience in performing pectus excavatum correction surgeries are likely to have better - honed skills. They have dealt with a wider range of cases, which allows them to handle complex situations more effectively. For example, a surgeon who has performed hundreds of Nuss or Ravitch procedures is likely to be more proficient than a relatively new surgeon.
• Success Rate: The success rate of surgeries is a crucial factor. A high success rate indicates that the doctor can achieve good cosmetic and functional results, such as proper repositioning of the sternum, improved lung function, and reduced pain for the patient. Success can also be measured by the low rate of post - operative complications.
• Patient Reviews: Feedback from previous patients can provide valuable insights into the doctor's bedside manner, communication skills, and the overall patient experience. Positive reviews regarding the doctor's ability to explain the procedure, answer questions, and provide support during the pre - and post - operative periods are important.
• Research and Publications: Doctors who are actively involved in research related to pectus excavatum, such as studying new surgical techniques or improving patient outcomes, are often at the forefront of the field. Their research can contribute to the advancement of treatment methods and the improvement of patient care.

Some Reputed Institutions and Doctors in New York City

• Columbia University Irving Medical Center: Their Chest Wall Abnormalities Program evaluates, monitors, and treats children and adolescents with a range of chest wall anomalies, including pectus excavatum. The multidisciplinary medical team includes pediatric surgeons, along with doctors from other pediatric specialties such as orthopedic surgery, plastic surgery, cardiology, pulmonology, genetics, and radiology. This comprehensive approach ensures that patients receive well - rounded care.
• NewYork - Presbyterian Morgan Stanley Children's Hospital: Affiliated with Columbia University Vagelos College of Physicians and Surgeons, it offers high - quality care for pediatric patients. The hospital likely has experienced surgeons who perform pectus excavatum correction surgeries.
• NYU Langone Health: NYU Langone has a team of experts in pediatric surgery. Their surgeons are trained to use the latest techniques for pectus excavatum correction, and they are committed to providing personalized care for each patient.

Charging Standards for Adolescent Pectus Excavatum Correction in New York City

Factors Affecting Charges

• Type of Procedure: The Ravitch procedure and the Nuss procedure have different cost structures. The Ravitch procedure, being an open surgery with more extensive tissue manipulation, may involve higher costs due to longer operating times, more intensive post - operative care, and the removal of cartilage. The Nuss procedure, on the other hand, is a minimally invasive technique, which generally has lower costs associated with shorter hospital stays, less blood loss, and less complex surgical equipment requirements. As per the study by Shale J. Mack et al., the charges also vary with the age of the patient, with patients over 30 years having higher charges ($67,014) compared to adolescents (12 - 17 years, $57,312) and young adults (18 - 29 years, $57,001) for the modified Nuss procedure.
• Hospital and Facility Fees: Different hospitals in New York City have different fee structures. High - end, well - equipped hospitals may charge more for their facilities, including the operating room, recovery room, and hospital stay. Additionally, some hospitals may have higher overhead costs, which are reflected in the patient's bill.
• Surgeon's Fee: The experience and reputation of the surgeon play a role in the fee. Highly experienced and well - known surgeons may charge more for their services. Their expertise and track record of successful surgeries justify the higher cost.
• Pre - and Post - operative Care: Pre - operative tests such as chest CT scans, pulmonary function tests, and echocardiograms add to the overall cost. Post - operative care, including pain management, follow - up appointments, and the removal of the surgical bar (if applicable), also contributes to the charges.
• Complications: If a patient experiences complications during or after the surgery, such as infections, bleeding, or nerve damage, the cost of treatment will increase. Additional procedures, medications, and longer hospital stays may be required to manage these complications.

Average Charges

While it is difficult to provide an exact average charge for adolescent pectus excavatum correction in New York City, based on general trends and the research available, the cost for a typical Nuss procedure for an adolescent may range from $50,000 to $70,000. This includes the surgeon's fee, hospital fees, and pre - and post - operative care. The Ravitch procedure may cost slightly more, perhaps in the range of $60,000 to $80,000, considering its more invasive nature. However, these are just rough estimates, and the actual charges can vary significantly depending on the factors mentioned above.

Insurance Coverage

• Private Insurance: Many private insurance plans cover pectus excavatum correction surgery, especially if it is deemed medically necessary. Medical necessity is often determined by factors such as the severity of the deformity (e.g., a Haller index greater than 3.25), the presence of symptoms like chest pain or breathing difficulties, and the impact on the patient's quality of life. However, insurance companies may have different criteria and requirements, and patients may need to get pre - authorization for the surgery.
• Medicaid: Medicaid is a state - based federally subsidized public insurance program. Eligibility and coverage for pectus excavatum correction vary by state. In some states, Medicaid may cover the surgery if it meets the state's medical necessity criteria.
• Out - of - Pocket Expenses: Even with insurance coverage, patients may still have out - of - pocket expenses, such as deductibles, copayments, and coinsurance. These expenses can add up, and patients should carefully review their insurance policies to understand their financial responsibilities.

Importance of Choosing the Right Doctor

Choosing the right doctor for adolescent pectus excavatum correction is of utmost importance. A skilled and experienced doctor can minimize the risk of complications during and after the surgery. Complications such as injury to the heart, lung collapse, pain, and the return of the deformity can be reduced with a competent surgeon. Moreover, a good doctor can provide personalized care and support throughout the treatment process. They can explain the procedure clearly to the patient and their family, answer all questions, and address any concerns. This helps in building trust and ensuring that the patient and family are well - informed and comfortable with the treatment decisions.

Pre - and Post - operative Care

Pre - operative Care

• Medical Exams and Tests: A complete medical exam and various medical tests are needed before the surgery. This includes 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. These tests help the doctor assess the patient's overall health and the severity of the pectus excavatum.
• Medication Management: Patients may be asked to stop taking certain medications before the surgery, such as aspirin, ibuprofen, naproxen, warfarin, and other blood - thinning drugs. This is to reduce the risk of excessive bleeding during the operation. The doctor will also provide instructions on which drugs the patient should still take on the day of surgery.
• Fasting: On the day of surgery, patients are usually asked not to drink or eat anything after midnight the night before. This is to prevent aspiration during the anesthesia.

Post - operative Care

• Hospital Stay: The length of the hospital stay varies depending on the type of procedure and the patient's recovery. For the Nuss procedure, the hospital stay is usually 1 to 2 days, while for the Ravitch procedure, it may be 3 to 5 days. During the hospital stay, the patient's vital signs are monitored, pain is managed, and the surgical site is checked for any signs of infection or complications.
• Pain Management: 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.
• Activity Restrictions: Initially, patients are not able to bend, twist, or roll from side to side. Activities are slowly increased as the patient recovers. When the patient can walk without help, they are usually ready to go home. Before leaving the hospital, the patient and their family will receive instructions on how to care for the surgical site, manage pain, and gradually increase activity levels.

Conclusion

Adolescent pectus excavatum is a common chest wall deformity that can have significant physical and psychological impacts on affected individuals. There are various treatment options available, including non - surgical and surgical methods. In New York City, patients have access to highly skilled doctors and advanced medical facilities for pectus excavatum correction. However, choosing the right doctor and understanding the charging standards and insurance coverage are crucial steps in the treatment process. Pre - and post - operative care also play vital roles in ensuring a successful recovery.

If you or someone you know is dealing with adolescent pectus excavatum, we encourage you to do further research, consult with multiple doctors, and ask questions to make an informed decision about the best course of treatment. Share this article with others who may benefit from this information, and feel free to explore more resources on our website for related topics.