{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T05:20:03Z","timestamp":1767849603312,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objective<\/jats:title><jats:p>This study aimed to investigate the relationship between bleb formation, primary spontaneous pneumothorax (PSP) and pectus excavatum (PE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From July 2005 to December 2016, the records of 514 patients with PE who underwent the Nuss procedure were obtained from a prospectively collected database and reviewed. Clinical features, images and treatments were analyzed retrospectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence rate of bleb formation was 26.5% in PE patients. The bleb group had a greater body height (174.4\u00a0cm vs. 170.4\u00a0cm, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), a higher Haller index (HI; 4.2 vs. 3.43, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and a higher risk of developing PSP than the non\u2010bleb group (risk ratio 9.8, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). HI values larger than 3.615 had good discriminatory power for predicting bleb formation in patients with PE. With each increase in the HI, PE patients had a 2.2\u2010fold greater odds ratio of bleb formation (odds ratio 2.221, CI 1.481\u20133.330, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We discovered that a high percentage of PE patients have bleb formation and a higher risk of PSP, especially those with an HI\u2009&gt;3.615. High\u2010resolution computed tomography of the chest may be useful for evaluating both the HI and the presence of blebs in the lungs before performing a corrective surgical procedure.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05412-6","type":"journal-article","created":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T17:02:44Z","timestamp":1581354164000},"page":"2035-2041","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Severity of Pectus Excavatum is a Risk Factor for Primary Spontaneous Pneumothorax"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4358-4822","authenticated-orcid":false,"given":"Hsu\u2010Kai","family":"Huang","sequence":"first","affiliation":[{"name":"Division of Thoracic Surgery, Tri\u2010Service General Hospital National Defense Medical Center No. 325, Section\u00a02, Cheng\u2010Kung Road, Neihu District 11490 Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi\u2010Jhih","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Tri\u2010Service General Hospital National Defense Medical Center No. 325, Section\u00a02, Cheng\u2010Kung Road, Neihu District 11490 Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuan\u2010Hsun","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Tri\u2010Service General Hospital National Defense Medical Center No. 325, Section\u00a02, Cheng\u2010Kung Road, Neihu District 11490 Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying\u2010Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Tri\u2010Service General Hospital National Defense Medical Center No. 325, Section\u00a02, Cheng\u2010Kung Road, Neihu District 11490 Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai\u2010Hsiung","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tri\u2010Service General Hospital National Defense Medical Center Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hung","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Tri\u2010Service General Hospital National Defense Medical Center No. 325, Section\u00a02, Cheng\u2010Kung Road, Neihu District 11490 Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shih\u2010Chun","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Tri\u2010Service General Hospital National Defense Medical Center No. 325, Section\u00a02, Cheng\u2010Kung Road, Neihu District 11490 Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsai\u2010Wang","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Tri\u2010Service General Hospital National Defense Medical Center No. 325, Section\u00a02, Cheng\u2010Kung Road, Neihu District 11490 Taipei 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