Download PDF
Eur J Pediatr Surg 2025; 35(03): 247-254
DOI: 10.1055/a-2507-8195
Original Article

Beyond the Chest Wall: Examining the Relationship between Morphological Features and Psychosocial Distress in Pectus Excavatum Patients

Nicky Janssen
1   Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, Limburg, The Netherlands
,
Jean H.T. Daemen
1   Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, Limburg, The Netherlands
,
Luca DRTG van Hulst
1   Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, Limburg, The Netherlands
,
Aimée J.P.M. Franssen
1   Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, Limburg, The Netherlands
,
Nadine A. Coorens
1   Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, Limburg, The Netherlands
,
Karel W.E. Hulsewé
1   Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, Limburg, The Netherlands
,
Yvonne L.J. Vissers
1   Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, Limburg, The Netherlands
,
Erik R. de Loos 
1   Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medisch Centrum Heerlen, Heerlen, Limburg, The Netherlands
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Introduction Pectus excavatum patients frequently experience psychosocial distress, yet the relationship with morphological features of the deformity remains unexplored. We hypothesize that certain morphological features analyzed by 3D optical surface imaging contribute more prominently to the distress experienced by pectus excavatum patients as they impact the visible severity of the deformity.

Materials and Methods Consecutive pectus excavatum patients who received three-dimensional optical surface imaging between August 2019 and November 2022 were included. Logistic regression analysis assessed the association between morphological features and psychosocial distress in which the distress was scored as a binary variable, based on a self-reported assessment.

Results Among 215 patients, 55% reported psychosocial distress with multivariable analyses revealing greater depth and length of the deformity being significantly correlated with psychosocial distress. However, this prediction model demonstrated a moderate discriminative ability with an area under the receiver operating characteristic curve of 0.66 (95% confidence interval [CI], 0.59–0.73) for pectus depth and 0.58 (95% CI, 0.51–0.66) for pectus length.

Conclusions The morphological features of length and depth of the deformity are correlated with psychosocial distress. Nonetheless, these individual features are weak predictors due to their moderate discriminative ability. This underscores that other patient-related factors, such as personality traits, neuropsychological conditions, and other psychosocial influences, are likely to play a role in the occurrence of psychosocial distress. Future studies should investigate these variables alongside the incorporation of standardized instruments for measuring psychosocial distress to better understand and address the distress in this population.

Keywords

pectus excavatum - 3D optical imaging - psychosocial functioning - morphological features


Publication History

Received: 31 July 2024

Accepted: 22 December 2024

Accepted Manuscript online:
24 December 2024

Article published online:
23 January 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Fokin AA, Steuerwald NM, Ahrens WA, Allen KE. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg 2009; 21 (01) 44-57
    CrossrefPubMedSearch in Google Scholar
  • 2 Kuru P, Bostanci K, Ermerak NO, Bahadir AT, Afacan C, Yuksel M. Quality of life improves after minimally invasive repair of pectus excavatum. Asian Cardiovasc Thorac Ann 2015; 23 (03) 302-307
    CrossrefPubMedSearch in Google Scholar
  • 3 Krasopoulos G, Dusmet M, Ladas G, Goldstraw P. Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity. Eur J Cardiothorac Surg 2006; 29 (01) 1-5
    CrossrefPubMedSearch in Google Scholar
  • 4 Jacobsen EB, Thastum M, Jeppesen JH, Pilegaard HK. Health-related quality of life in children and adolescents undergoing surgery for pectus excavatum. Eur J Pediatr Surg 2010; 20 (02) 85-91
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Hanna WC, Ko MA, Blitz M, Shargall Y, Compeau CG. Thoracoscopic Nuss procedure for young adults with pectus excavatum: excellent midterm results and patient satisfaction. Ann Thorac Surg 2013; 96 (03) 1033-1036 , discussion 1037–1038
    CrossrefPubMedSearch in Google Scholar
  • 6 Viggiano D, Bongiolatti S, Borgianni S, Lo Piccolo R, Voltolini L, Gonfiotti A. Nuss technique for pectus excavatum in adult patients: cosmetic satisfaction and improvement of quality of life in a single-center experience. Front Surg 2022; 9: 903791
    CrossrefPubMedSearch in Google Scholar
  • 7 Zuidema WP, Oosterhuis JWA, Zijp GW, van der Heide SM, van der Steeg AFW, van Heurn LWE. Early consequences of pectus excavatum surgery on self-esteem and general quality of life. World J Surg 2018; 42 (08) 2502-2506
    CrossrefPubMedSearch in Google Scholar
  • 8 Haller Jr JA, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg 1987; 22 (10) 904-906
    CrossrefPubMedSearch in Google Scholar
  • 9 St Peter SD, Juang D, Garey CL. et al. A novel measure for pectus excavatum: the correction index. J Pediatr Surg 2011; 46 (12) 2270-2273
    CrossrefPubMedSearch in Google Scholar
  • 10 Coorens NA, Daemen JHT, Slump CH. et al. The automatic quantification of morphological features of pectus excavatum based on three-dimensional images. Semin Thorac Cardiovasc Surg 2022; 34 (02) 772-781
    CrossrefPubMedSearch in Google Scholar
  • 11 Coorens NA, Daemen JHT, Slump CH. et al. Predicting aesthetic outcome of the Nuss procedure in patients with pectus excavatum. Semin Thorac Cardiovasc Surg 2023; 35 (03) 627-637
    CrossrefPubMedSearch in Google Scholar
  • 12 Daemen JHT, Loonen TGJ, Coorens NA. et al. Photographic documentation and severity quantification of pectus excavatum through three-dimensional optical surface imaging. J Vis Commun Med 2020; 43 (04) 190-197
    CrossrefPubMedSearch in Google Scholar
  • 13 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014; 12 (12) 1495-1499
    CrossrefPubMedSearch in Google Scholar
  • 14 Lawson ML, Cash TF, Akers R. et al. A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum. J Pediatr Surg 2003; 38 (06) 916-918
    CrossrefPubMedSearch in Google Scholar
  • 15 Kelly Jr RE, Cash TF, Shamberger RC. et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study. Pediatrics 2008; 122 (06) 1218-1222
    CrossrefPubMedSearch in Google Scholar
  • 16 Grant SW, Hickey GL, Head SJ. Statistical primer: multivariable regression considerations and pitfalls. Eur J Cardiothorac Surg 2019; 55 (02) 179-185
    CrossrefPubMedSearch in Google Scholar
  • 17 Yan LI, Wong AY, Cheung JP. et al. Psychosocial interventions for teenagers with adolescent idiopathic scoliosis: a systematic literature review. J Pediatr Nurs 2023; 73: e586-e593
    CrossrefPubMedSearch in Google Scholar
  • 18 Hunt O, Burden D, Hepper P, Johnston C. The psychosocial effects of cleft lip and palate: a systematic review. Eur J Orthod 2005; 27 (03) 274-285
    CrossrefPubMedSearch in Google Scholar
  • 19 Salinero LK, Romeo DJ, Pontell ME. et al. Psychosocial status and self-perception in patients with cleft lip and/or palate. Cleft Palate Craniofac J 2024;
    CrossrefPubMedSearch in Google Scholar
  • 20 de Hond AAH, Steyerberg EW, van Calster B. Interpreting area under the receiver operating characteristic curve. Lancet Digit Health 2022; 4 (12) e853-e855
    CrossrefPubMedSearch in Google Scholar
  • 21 Alcaraz-Ibáñez M, Sicilia A, Paterna A. Examining the associations between the Big Five personality traits and body self-conscious emotions. PsyCh J 2020; 9 (03) 392-401
    CrossrefPubMedSearch in Google Scholar
  • 22 Taurines R, Schwenck C, Westerwald E, Sachse M, Siniatchkin M, Freitag C. ADHD and autism: differential diagnosis or overlapping traits? A selective review. Atten Defic Hyperact Disord 2012; 4 (03) 115-139
    CrossrefPubMedSearch in Google Scholar
  • 23 Volders JH, Negenborn VL, Haloua MH. et al. Breast-specific factors determine cosmetic outcome and patient satisfaction after breast-conserving therapy: results from the randomized COBALT study. J Surg Oncol 2018; 117 (05) 1001-1008
    CrossrefPubMedSearch in Google Scholar
  • 24 Brands-Appeldoorn ATPM, Maaskant-Braat AJG, Janssen L, van Osch LADM, Tjan-Heijnen VCG, Roumen RMH. Breast cancer patient-reported outcome of factors influencing cosmetic satisfaction after breast-conserving therapy. Breast Cancer 2022; 29 (01) 114-120
    CrossrefPubMedSearch in Google Scholar
  • 25 Nuzzi LC, Cerrato FE, Webb ML. et al. Psychological impact of breast asymmetry on adolescents: a prospective cohort study. Plast Reconstr Surg 2014; 134 (06) 1116-1123
    CrossrefPubMedSearch in Google Scholar
  • 26 Marks MW, Argenta LC, Lee DC. Silicone implant correction of pectus excavatum: indications and refinement in technique. Plast Reconstr Surg 1984; 74 (01) 52-58
    CrossrefPubMedSearch in Google Scholar
  • 27 Caro C, Freude W, Florek A. et al. Simultaneous correction of a pectus excavatum with tubular breast deformity using a custom-made silicone implant. Arch Gynecol Obstet 2021; 303 (04) 1025-1037
    CrossrefPubMedSearch in Google Scholar
  • 28 Ho Quoc C, Delaporte T, Meruta A, La Marca S, Toussoun G, Delay E. Breast asymmetry and pectus excavatum improvement with fat grafting. Aesthet Surg J 2013; 33 (06) 822-829
    CrossrefPubMedSearch in Google Scholar
  • 29 Palenzuela-Luis N, Duarte-Clíments G, Gómez-Salgado J, Rodríguez-Gómez JÁ, Sánchez-Gómez MB. Questionnaires assessing adolescents' self-concept, self-perception, physical activity and lifestyle: a systematic review. Children (Basel) 2022; 9 (01) 91
    PubMedSearch in Google Scholar
  • 30 Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996; 49 (12) 1373-1379
    CrossrefPubMedSearch in Google Scholar
  • 31 Peduzzi P, Concato J, Feinstein AR, Holford TR. Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates. J Clin Epidemiol 1995; 48 (12) 1503-1510
    CrossrefPubMedSearch in Google Scholar
  • 32 Riley RD, Snell KIE, Ensor J. et al. Minimum sample size for developing a multivariable prediction model: part I - continuous outcomes. Stat Med 2019; 38 (07) 1262-1275
    CrossrefPubMedSearch in Google Scholar
  • 33 Daemen JHT, Loonen TGJ, Verhulst AC. et al. Three-dimensional imaging of the chest wall: a comparison between three different imaging systems. J Surg Res 2021; 259: 332-341
    CrossrefPubMedSearch in Google Scholar