• David M Notrica.
• Department of Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, United States; Department of Surgery, Mayo Clinic College of Medicine and Science, 5757 East Mayo Boulevard, Phoenix AZ 85054, United States; Department of Child Health, University of Arizona College of Medicine Phoenix, 1919 East Thomas Road, Phoenix, AZ 85016, United States. Electronic address: dnotrica@phoenixchildrens.com.
• Semin. Pediatr. Surg. 2019 Jun 1; 28 (3): 172-177.

AbstractIn 1998, Donald Nuss changed the way the world thought about the surgical repair of pectus excavatum. The new operation adheres to sound orthopedic fundaments, but has a significantly higher learning curve than other operations in pediatric surgery. Variations in pectus excavatum type, severity, symmetry and chest wall pliability bring challenges. This article will detail common error traps and ways to avoid them when performing the Nuss procedure. As recent publications have shown, an operation done more than 50,000 times across the world may bring to light infrequent but devastating outcomes that may be preventable. The critical view of safety for pectus repair is discussed, as are areas where a culture of safety could optimize results on a larger scale. We will review potential opportunities to improve outcomes by identifying error traps in the preoperative, intraoperative, and postoperative care of patients undergoing the Nuss procedure.Copyright © 2019 Elsevier Inc. All rights reserved.

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