Danielle H. Rochlin, Marta M. Gilson, Kendall Likes, Emma Graf, Nancy Ford, Paul J. Christo, Julie A. Freischlag
Johns Hopkins Medical Institutions, Baltimore, MD.
OBJECTIVES: Long-term outcomes after first rib resection and scalenectomy (FRRS) for treatment of neurogenic thoracic outlet syndrome (NTOS) are understudied, but believed to decrease over time. Our goal was to evaluate long-term NTOS outcomes with validated quality of life (QOL) instruments.
METHODS: Three surveys (Short-Form 12, Brief Pain Inventory, and Cervical Brachial Symptom Questionnaire) were mailed to 162 NTOS patients aged ≥18 treated by FRRS from 2003-2010. Demographic and clinical data was extracted from patient records. Each FRRS was categorized based on postoperative clinical assessment. ANOVA and linear regression were used.
RESULTS: Survey yield was 54% (n=87) with a mean 44.7 months follow-up (range 12.4-91.9). There was no significant difference in QOL scores associated with longer follow-up (Figure 1). Poorer scores on all surveys were associated with comorbid chronic pain syndromes, opioid use, and unfavorable clinical assessment (p<0.05). Poorer scores on select surveys were associated with smoking, age ≥40 years, neck/shoulder disease, postoperative injections, and complications (p<0.05). A positive preoperative scalene block was not significantly associated with most long-term scores.
CONCLUSIONS: QOL after FRRS shows no significant deterioration with longer follow-up. Clinical assessment reflects patient-reported outcomes. Patient factors, such as comorbidities and opioid use, are more predictive of long-term QOL than a preoperative scalene block and should be considered during surgical selection.
AUTHOR DISCLOSURES: P. J. Christo, Nothing to disclose; N. Ford, Nothing to disclose; J. A. Freischlag, Nothing to disclose; M. M. Gilson, Nothing to disclose; E. Graf, Nothing to disclose; K. Likes, Nothing to disclose; D. H. Rochlin, Nothing to disclose.
Figure: No significant difference with longer follow-up for Short-Form 12 (SF-12) physical component score (PCS), and all other scores (not shown).
Posted April 2012