The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on placement of pectus bar for pectus excavatum (Nuss procedure).
It replaces the previous guidance on minimally invasive placement of pectus bar (NICE interventional procedure guidance 3, August 2003).
Pectus excavatum is an abnormality of the chest in which the breastbone sinks inward (sometimes called funnel chest). Problems associated with pectus excavatum are mainly cosmetic, although the condition can impair cardiac and respiratory function. Placement of a pectus bar for pectus excavatum (also known as the Nuss procedure) involves placing one or two steel (pectus) bars under the breastbone with the aim of raising it and correcting the abnormal shape. The bar, which is bent into a curve to fit the patient’s chest, is inserted through small openings in the chest. The bar (or bars) are usually removed within a few years of placement.
T02.1 Correction of pectus deformity of chest wall
Includes: Correction of pectus carinatum
Correction of pectus excavatum
Y74.1 Thoracoscopically assisted approach to thoracic cavity (if used)
Y02.2 Insertion of prosthesis into organ NOC
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.