The evaluation of the correlation between the haller index and the correction index in patients with pectus excavatum

Introduction: Pectus excavatum is a frequently seen congenital deformity in the anterior wall of the rib cage. This condition is characterized by the incompatible development of cartilage tissue and bone tissue at the point where the ribs meet the sternum, resulting in the sternum collapsing inwards or creating a cavity in the anterior wall of the rib cage. Any change in the position of the sternum, either inward or outward into the rib cage, can affect the normal development of the rib cage. Pectus excavatum is usually noticed in childhood and may become evident in adolescence. This deformity in the anterior chest wall can change the form of the rib cage to the extent that it can negatively affect respiratory and cardiac functions. Treatment often depends on the severity of symptoms and the age of the patient, and in some cases, surgical intervention may be required. With the frequent use of the Nuss procedure, which is a minimally invasive type of surgery, correction of the pectus excavatum defect has become more common than in previous years, with the studies carried out. Purpose: The aim of this study is to calculate the measurement values of the Haller Index (HI) and Correction Index (CI), which can be detected by thorax computed tomography, which are used to characterize the disease from the moment of application to the diagnosis of pectus excavatum patients, and to determine the relationship between them and the relationship between these values and parameters such as age and gender. To investigate whether CI measurement values have a significant correlation with HI values and whether CI can be considered as an indication for surgery. Patients and Methods: 212 patients who applied to Çukurova University Faculty of Medicine, Department of Thoracic Surgery between 2012 and 2024 due to pectus excavatum deformity were retrospectively examined. 115 patients were included in the study. In order to examine the pectus excavatum deformity, HI and CI values were calculated separately in the preoperative thorax computed tomographies of the identified patients. Considering the pectus excavatum degrees and measurement indexes, patient groups who were operated on with the Nuss procedure and those who were not operated on were classified and the relationship between the index values was investigated. Results: 115 patients were included in our study. 85 of the patients were operated on, and 30 patients were included in the statistical analysis as the non-operated control group. In our study, the average age of the patients was 16.6±3.2; The average age of the operated patients was 16.2±3.1; The average age of the patients who were not operated on was 17.7±3.2 years. The average age of patients who were not operated on was found to be significantly higher. In our study, 92 (80%) of the patients were male and 23 (20%) were female; Of those who were operated on, 68 (80%) were men and 17 (20%) were women, and among those who were not operated on, 24 (80%) were men and 6 (20%) were women. The mean HI of all patients was 4.01±1.71, the mean HI of those who were operated on was 4.38±1.85, and the mean HI of those who were not operated was 2.99±0.37. HI values of operated patients were found to be significantly higher. The mean CI of all patients was 34.99±15.02%, the mean CI of those who were operated on was 38.48±15.83%, and the mean CI of those who were not operated was 25.10±4.88%.CI values of operated patients were found to be significantly higher. Strong significant correlation between HI and CI in the whole group (p<0.05); A strong significant correlation was found between HI and CI in operated patients (p<0.05) and a moderately significant correlation between HI and CI in non-operated patients. Of the patients with a Haller index over 3.25, 55 (77.5%) had a SA above 28%, and 16 (22.5%) had a SA below 28%; Of the patients with a state index below 3.25, 5 (1.4%) had a SA above 28%, and 39 (88.6%) had an SA below 28%. No correlation was found between age and HI and CI in the entire group, in operated and non-operated patients. (p>0.05). No significant difference was detected between the CI values of operated and non-operated patients. The average length of stay in operated patients was 6.6±2.7 (Min: 4, Max: 28) days, and it was determined that the length of stay showed a low-level significant correlation with HI and CI. The area under the curve (AUC) for HI was 0.835 cm2, and the sensitivity was calculated as 80% and specificity as 76.5% for the cut-off value of 3.25. The AUC for CI was 0.783 cm2, and for the cut-off value of 28%, the sensitivity was calculated as 83.3% and the specificity as 64.7%. In our study, 1 (1.2%) patient developed an intraoperative complication, 1 (1.2%) patient developed a wound infection, and 1 (1.2%) patient had a bar slip. In our study, 1 (1.2%) patient died on the 28th postoperative day. Conclusion: A high correlation was found between HI and CI. We recommend surgical repair in cases of PE with a CI of 28% or more, as this value correlates significantly with the long-accepted standard (HI ≥3.25). In various studies and in our study, a transversely wide chest increases HI, regardless of the degree of deformity, and on the contrary, a transversely narrow chest diameter decreases HI. In the same studies, the degree of depression can be calculated more precisely because the transverse width of the chest is not included in the equation of CI. stated. Although it has been concluded that HI is a superior indicator than CI based on imaging results, based on previous studies published in the literature, we argue that CI is a more appropriate evaluation method than HI, which directly evaluates pectus severity as a result of computed tomography imaging. As a result of many studies conducted on patients with PE in the medical world and accepted all over the world, studies have reported that CI reduces the frequency of unnecessary surgical repair by at least 10% compared to HI. We reached similar results in this study and we think that CI is a more appropriate criterion as an indication for surgery in patients with PE compared to the HI measurement value.