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Does Surgical Intervention for Thoracic Outlet Syndrome Improve Patient’s Quality of Life?

Ricardo DeLeon, David C. Chang, Lisa Rotellini-Coltvet, Julie A. Freischlag.
Johns Hopkins School of Medicine, Baltimore, Md.

OBJECTIVES: To assess long-term quality of life outcomes in patients following transaxillary first-rib resection and scalenectomy for thoracic outlet syndrome (TOS).

METHODS: This was a prospective observational study using the Short-Form 12 (SF-12) and Disability of Arm, Hand, and Shoulder (DASH) instruments between 2/2005 and 1/2008 in patients with TOS presenting to an academic medical center for pre-operative surgical evaluation after failing a physical therapy protocol. Surveys were conducted pre-operatively and then again at 3, 6, 12, 18, and 24 months after surgery. Longitudinal data analysis was performed with population-averaged models using generalized estimating equations (GEE) method.

RESULTS: A total of 62 out of 128 eligible patients (48.4%) completed the study protocol (39 neurogenic; 23 venous), returning 210 valid SF-12 surveys (141 neurogenic; 69 venous) and 161 valid DASH surveys (54 neurogenic; 107 venous). Neurogenic patients had baseline SF-12 Physical Component Scores (PCS) similar to chronic heart failure patients, and were significantly worse than venous patients (33.6 vs. 43.0, p<0.05). In contrast, no difference existed in Mental Component Scores (MCS) (43.9 vs. 43.9, p=n.s.) In follow-up, on average, PCS scores for neurogenic patients improved 0.28 points (p<0.001) and MCS scores improved 0.16 points per month (p=0.03); while PCS scores for venous patients improved 0.53 points (p=0.001) and MCS scores improved 0.55 points per month (p<0.001) [Figures 1-4]. Additionally, neurogenic patients had baseline DASH scores that were similar to patients with rotator cuff tears, and they were also significantly worse than venous patients (53.2 vs. 26.9, p<0.001). DASH scores, on average, also improved 0.99 points (p<0.001) for neurogenic patients and 0.83 points (p=0.001) for venous patients per month.

CONCLUSIONS: The use of the SF-12 and DASH instruments in patients with TOS demonstrated significant improvement in patients postoperatively. Venous TOS patients typically improved both physical and mental scores in shorter periods of time than their neurogenic counterparts. We conclude that in appropriately selected patients with either neurogenic or venous TOS, surgical intervention does improve their quality of life over time.

AUTHOR DISCLOSURES: R. DeLeon, None; D.C. Chang, None; L. Rotellini-Coltvet, None; J.A. Freischlag, None.