Does A High Haller Index Impact Outcomes in Pectus Excavatum Repair?

OBJECTIVE: Severity for pectus excavatum includes Haller index >3.25. An extremely high Haller index (≥8) may influence surgical approach and complications. This study reviews outcomes of high Haller index patients after repair.

METHODS: A single institution retrospective analysis was performed on adult patients with Haller index ≥8 undergoing pectus excavatum repairs. For outcomes, a propensity-matched control group with a Haller index ≤4 was utilized.

RESULTS: In total, 64 cases (mean age 33.5 ±10.9 years, Haller index 13.1 ±5.0; 56% females) were included. A minimally invasive repair was successful in 84%. A hybrid procedure was performed in the remaining either to repair fractures of the ribs (8 patients) and sternum (5 patients) or when osteotomy and/or cartilage resection is required (10 patients). In comparison with the matched cohort (Haller index ≤4), high Haller index cases had longer operative times (171 vs. 133 minutes, p<.001), more frequently required Hybrid procedures (16% vs. 2%, p=0.005), experienced higher incidences of rib (22% vs. 3%, p=0.001) and sternal fractures (12% vs. 0%, p=0.003), and had increased repair with 3 bars (50% vs. 19%, p<0.001). There were no significant differences between the groups for length of hospital stay or postoperative 30-day complications.

CONCLUSION: Patients with an extremely high Haller index can be challenging cases with greater risks of fracture and need for osteotomy/cartilage resection. Despite this, minimally invasive repair techniques can be utilized in most cases without increased complications when performed by an experienced surgeon.