Time heals: The impact of waiting times on pediatric patients’ decisions to decline pectus surgery

Background: This study investigates the impact of waiting times, due to Covid-19, on patients' decisions to undergo surgery for pectus deformities. Methods: We conducted a cross-sectional study of patients (>18 years) on the pectus surgery waitlist at the Amsterdam Pectus Centre. Patients were contacted in January 2025. Primary outcome was the proportion of patients still wanting surgery. Secondary outcomes included symptom progression, reasons and predictive factors for withdrawal (Ravitch surgery, age at waitlist entry, male sex, physical and psychosocial symptoms at waitlist entry). Predictive factors were analyzed using multivariable logistic regression. Results: Of 141 contacted patients, 75.9 % (107/141) were included. Age at waitlist entry was 16.0 years (IQR 15.0–17.0). After an average wait of 56.6 months (SD 22.2), only 52.3 % (23/44) of pectus excavatum, 30.9 % (17/55) of pectus carinatum/arcuatum and 37.5 % (3/8) of flaring patients still wanted surgery. Reasons for withdrawal differed: pectus excavatum patients most often cited body acceptance, while pectus carinatum/arcuatum patients most frequently mentioned strength training. Patients who withdrew showed greater reductions in physical (69.6 % versus 25.9 %, P = 0.002) and psychosocial symptoms (95.2 % versus 53.8 %, P = 0.004) than patients still wanting surgery. Thirteen patients were treated conservatively while awaiting surgery, with a 35.5 % success rate. Age (OR = 0.53, 95 %-CI = 0.33-0.86, P = 0.01) and physical symptoms (OR = 0.37, 95 %-CI = 0.15-0.94, P = 0.04) at waitlist entry were predictors of withdrawal from surgery. Conclusions: After prolonged waiting, 59.8 % of all patients withdrew from surgery, primarily due to body acceptance and physical development. Psychological counseling and strength training should be integrated into pectus care, particularly for young, asymptomatic patients.