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 SS17. Supraclavicular Decompression for Neurogenic Thoracic Outlet Syndrome (NTOS) in Pediatric and Adult Populations: Differential Patient Characteristics and Clinical Outcomes

​Francis J. Caputo, Anna M. Wittenberg, Chandu Vemuri, Valerie B. Emery, Robert W. Thompson
Surgery, Washington University in St. Louis, St. Louis, MO.

OBJECTIVES: To better understand factors determining responsiveness to treatment, patient characteristics and postoperative outcomes were examined in a series of pediatric and adult patients undergoing supraclavicular decompression for NTOS.

METHODS: Data were obtained for patients undergoing primary supraclavicular decompression for NTOS from 2008-2010 (n=189), and clinical characteristics were compared between pediatric patients (age<21, n=35) and adults (age>21, n=154). Functional outcomes were assessed before and 6 months after surgery using a composite NTOS Index combining the Disabilities of the Arm, Shoulder and Hand (DASH), the Cervical-Brachial Symptom Questionnaire (CBSQ), and a 10-point Visual Analog pain scale.

RESULTS: Pediatric and adult patients were similar with respect to gender (72.5% female), side affected (58.7% right), bony anomalies (23.3%), previous injury (55.6%), coexisting pain disorders (11.1%), and positive response to scalene muscle anesthetic blocks (95.6%). Compared to adults, pediatric patients had a significantly (p<0.05) lower incidence of depression (11.4% vs. 41.6%), motor vehicle injury (5.7% vs. 20.1%), and preoperative use of opiate medications (17.1% vs. 44.8%). Mean preoperative NTOS Index was significantly lower in pediatric vs. adult patients (152.0±11.8 vs. 187.9±5.3) and postoperative length of hospital stay was 4.4±0.2 vs. 4.9±0.1 days (p=0.03). Although both groups exhibited significant improvement in functional outcome measures at 6-month follow-up, compared to adults the pediatric patients had significantly lower NTOS Index (33.4±10.1 vs. 127.1±10.2, p<0.0001) and use of opiate medications (11.4% vs. 47.4%, p<0.0001).

CONCLUSIONS: Pediatric patients undergoing supraclavicular decompression for NTOS had more favorable preoperative characteristics and enhanced 6-month functional outcomes as compared to adults. Further study is needed to delineate the age-dependent and age-independent factors that promote optimal surgical outcomes for NTOS.

AUTHOR DISCLOSURES: F. J. Caputo, Nothing to disclose; V. B. Emery, Nothing to disclose; R. W. Thompson, Nothing to disclose; C. Vemuri, Nothing to disclose; A. M. Wittenberg, Nothing to disclose.

Posted April 2012

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