O3311: Impaired Quality of Life is Independent of Physical Symptoms and Haller Index in Pectus Excavatum

Background: Criteria for surgical repair of pectus excavatum (PE) includes anatomical severity (Haller Index (HI) ≥ 3.25) and the presence of physical symptoms. However, physical deformity associated with chest wall concavity can cause anxiety, depression, and impaired health-related quality of life (HRQOL). Previously, we demonstrated that HRQOL impairment is not associated with HI with no difference in incidence in patients who met the current criteria for surgery versus those who did not. This study aims to investigate the correlation between HRQOL impairment and physical symptoms. We hypothesize that impairment is independent of symptom presence.

Methods: A prospective observation study was performed of all pediatric patients (≤18 years) who were seen in consultation for PE from August 2021 to July 2024. A self-assessment containing the validated Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) was administered. HI and physical symptoms (shortness of breath (SOB), chest pain, exercise intolerance) were abstracted from the electronic medical record. Based on the HI or physical exam, patients were categorized into two groups: HI ≤ 3.24 or mild and HI ≥3.25 or severe. Total HRQOL was considered impaired if it fell below the minimal clinically important difference compared to healthy population controls. Univariate analysis (Chi-Squared, Fischer’s Exact, Mann-Whitney-U) and Spearman’s correlation coefficient were utilized. IRB#HSC-MS-24-1267.

Results: During the study period, 56 patients completed the self-assessment. The median age was 14 (IQR 13-15), and 86% were male. HI ≥3.25 was present in 55% (31) of patients. Overall, 52% (30) had an impaired total HRQOL score with no difference by HI grouping (52% vs 51%, p=0.97). There was no difference in physical (p=0.40), emotional (0.39), social (0.59), or school (0.96) mean subscores by HI grouping. Shortness of breath (SOB) was reported in 68% (48% vs 84%, p<.001) and exercise intolerance in 59% (40% vs 74%, p=0.01), both differing between groups. Chest pain was experienced by 56% and did not differ by HI grouping (54% vs 56% p=0.88). Impaired total HRQOL score was not associated with SOB (p=0.08), exercise intolerance (p=0.29), or chest pain (p=0.79) (FIGURE). No physical symptoms were reported in 25% of patients, 1 symptom in 9%, 2 symptoms in 23%, and 3 symptoms in 50%. Spearman’s rank correlation coefficient between the continuous HRQOL score and the number of symptoms was weak and non-significant (ρ=0.12, p=0.38).

Conclusion: Impaired total HRQOL scores are seen in children with PE regardless of severity. Despite physical symptoms of SOB and exercise intolerance occurring with higher rates in patients with higher HI, impaired HRQOL was not associated with physical symptoms. The criteria for surgical repair of PE should be extended to include mental health qualifications.