P1.052: Variability in Pectus Excavatum Treatment Based on Neighborhood Opportunities

Background: Pectus Excavatum (PE) is the most common chest wall deformity, characterized by inward depression of the sternum and costal cartilages. Treatment is offered for significant deformities which may cause symptoms of pain, exercise intolerance, and cardiac dysfunction, as well as significant impact on body image and psychosocial well being. Corrective options include vacuum bell (VB) therapy and surgery, most often via minimally invasive repair. Given the elective nature of pectus intervention, we hypothesized that patients with lower Child Opportunity Index (COI) have variable referral and treatment routes compared to those with high COI. Our study investigates the relationship between COI, referral patterns, and PE treatment choice.

Methods: A retrospective analysis of surgical clinic encounters of patients referred for evaluation of pectus excavatum at a single tertiary pediatric hospital from 2015 to 2024 was performed. We evaluated COI neighborhood levels (very low, low, moderate, high, very high opportunity) based on zip code of residence, which were further categorized by education, health, and socioeconomic domains. These COI domains were then ranked relative to national neighborhoods and state neighborhoods to differentiate opportunities between states. We then evaluated variability in PE treatment (no intervention, VB therapy, or surgery) based on these COI indices. Chi-squared and Fisher’s exact test were used for analysis, comparing high/very high COI versus very low/low/moderate COI.

Results: A total of 1121 patients were analyzed. Out of these patients, 788 (70.3%) had no intervention, 215 (19.2%) had only VB therapy, and 118 (10.5%) had surgical intervention. A majority (83.5%) of the patients referred for a clinic evaluation were overall high/very high COI. There was no significant difference comparing treatment choice by COI levels when nationally-normalized. When comparing state-normalized COIs, there was no significance within the education and health domains. Within the state-normalized socioeconomic domain, there was a significantly higher percentage of patients who had VB therapy or surgery within the high/very high levels compared to very low/low/moderate levels (21.4% vs. 16% VB and 12.3 % vs 8% surgery; Table 1). The same was reflected in overall COI (Figure 1). In contrast, patients in very low/low/moderate COI had a higher percentage of no intervention compared to high/very high COI levels (76% vs. 66.6%; Table 1).

Conclusion: There is variability in referral to surgery clinic and ultimately treatment choice among children with PE. Lower socioeconomic domain within COI correlated with higher rates of no intervention. Conversely, the higher socioeconomic domain correlated with higher rates of intervention (VB or surgery). While aspects of PE treatment were not captured in our analysis, there may be financial burdens that warrant further investigation and education with hopes to ultimately mitigate inequity within PE treatment.