{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:06:31Z","timestamp":1790118391022,"version":"4.0.1"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study aims to evaluate the incidence and characteristics of Nuss bar infections, identify factors associated with infection, and present our institutional management considerations.<\/jats:p>\n                  <jats:p>We conducted a single-center retrospective cohort study of patients undergoing the Nuss procedure between 1999 and 2024 at Amsterdam Pectus Center. All patients had a minimum follow-up of 6 months. Primary outcomes included incidence and management of infections. Secondary outcomes included infection characteristics (early- [&lt;30 days] vs. late-onset [&gt;30 days], superficial vs. deep), diagnostics, microbiology, factors associated with infection (sex, age, type of anesthesia, number of bars, bar dislocation, stabilizer position, use of sutures), impact on bar removal, incidence of allergies and terra firma-forme dermatosis.<\/jats:p>\n                  <jats:p>Of 695 patients, 4.0% (n\u2009=\u200928\/695) developed Nuss bar infections, at a median of 2.0 (0.0\u201313.5) months postoperative, presenting with erythema, pain, and exudate. Over time, infections shifted from early- to late-onset (p\u2009=\u20090.03). Deep infections (71.4%, n\u2009=\u200920\/28) more often required surgery (p\u2009=\u20090.007); superficial infections were managed with a wide range of antibiotics. Bar dislocations (5.6%, n\u2009=\u200939\/695) and stabilizer plate loosening (1.0%, n\u2009=\u20097\/695) required reoperation and were associated with infections (p\u2009=\u20090.001). Operative time for bar removal was longer in infected patients (52.0 [32.0\u201368.0] vs. 35.0 [26.0\u201349.0] minutes, p\u2009=\u20090.03). One case of cobalt allergy was identified. Terra firma-forme dermatosis (0.4%, n\u2009=\u20093\/695) was treated with alcohol wipes.<\/jats:p>\n                  <jats:p>Bar dislocation and stabilizer plate loosening are associated with Nuss bar infections. We present our institutional management considerations based on retrospective data and experience, requiring prospective validation. Accurate diagnostics, tailored antibiotic therapy, and consideration of alternative diagnoses remain essential.<\/jats:p>","DOI":"10.1055\/a-2888-9665","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T23:13:46Z","timestamp":1780960426000},"page":"385-392","source":"Crossref","is-referenced-by-count":0,"title":["Bar-Related Infections After Minimally Invasive Repair of Pectus Excavatum: A 25-Year Single-Center Retrospective Cohort Study"],"prefix":"10.1055","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6555-427X","authenticated-orcid":false,"given":"Hendrik","family":"van Braak","sequence":"additional","affiliation":[{"name":"Emma Kinderziekenhuis Amsterdam UMC, Netherlands","place":["Amsterdam"],"department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika P. M.","family":"van Elzakker","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Centres, Netherlands","place":["Amsterdam"],"department":["Department of Medical Microbiology and Infection Prevention"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sjoerd A.","family":"de Beer","sequence":"additional","affiliation":[{"name":"Emma Kinderziekenhuis Amsterdam UMC, Netherlands","place":["Amsterdam"],"department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs W. N.","family":"Oomen","sequence":"additional","affiliation":[{"name":"Emma Kinderziekenhuis Amsterdam UMC, Netherlands","place":["Amsterdam"],"department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"Zwaveling","sequence":"additional","affiliation":[{"name":"Emma Kinderziekenhuis Amsterdam UMC, Netherlands","place":["Amsterdam"],"department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lodewijk W. E.","family":"van Heurn","sequence":"additional","affiliation":[{"name":"Emma Kinderziekenhuis Amsterdam UMC, Netherlands","place":["Amsterdam"],"department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin R.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Emma Kinderziekenhuis Amsterdam UMC, Netherlands","place":["Amsterdam"],"department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/S0022-3468(98)90314-1","article-title":"A 10-year review of a minimally invasive technique for the correction of pectus excavatum","volume":"33","author":"D Nuss","year":"1998","journal-title":"J Pediatr Surg"},{"issue":"09","key":"ref2","doi-asserted-by":"crossref","first-page":"5150","DOI":"10.21037\/jtd-23-87","article-title":"Minimally invasive repair of pectus excavatum in adults: a review article of presentation, workup, and surgical treatment","volume":"15","author":"M R Aly","year":"2023","journal-title":"J Thorac Dis"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/j.jpedsurg.2018.02.090","article-title":"Multivariate analysis of risk factors for Nuss bar infections: a single center study","volume":"53","author":"R J Obermeyer","year":"2018","journal-title":"J Pediatr Surg"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.jpedsurg.2015.10.036","article-title":"Risk factors and management of Nuss bar infections in 1717 patients over 25 years","volume":"51","author":"R J Obermeyer","year":"2016","journal-title":"J Pediatr Surg"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s00383-021-05049-z","article-title":"\u201cWhen to Nuss? Patient age as a risk factor for complications of minimally invasive repair of pectus excavatum: a systematic review and meta-analysis.\u201d","volume":"38","author":"A C Coughlin","year":"2022","journal-title":"Pediatr Surg Int"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.jpedsurg.2003.11.012","article-title":"Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications","volume":"39","author":"H J Park","year":"2004","journal-title":"J Pediatr Surg"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/S0022-3468(00)90019-8","article-title":"Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases","volume":"35","author":"A Hebra","year":"2000","journal-title":"J Pediatr 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