30-Day Outcomes Following Surgical Decompression of Neurogenic Thoracic Outlet Syndrome

• Published in: Canadian journal of plastic surgery Vol. 25; no. 2; pp. 120 - 121
• Main Authors: Maqbool, T, Novak, C B, Jackson, T, Baltzer, H
• Format: Journal Article
• Language: English
• Published: Montreal SAGE PUBLICATIONS, INC 01.07.2017
• Subjects: Plastic surgery
• ISSN: 2292-5503; 2292-5511

Purpose: The purpose of this study was to evaluate early postoperative outcomes following brachial plexus surgical decompression in the thoracic inlet to relieve symptoms of neurogenic thoracic outlet syndrome (nTOS). We hypothesized that first and/ or cervical rib resection would be associated with increased 30day complications and healthcare utilization. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for all cases of surgical decompression from 2005 to 2013 was reviewed. Results: There were 225 eligible patients (females: 68.4%; mean age: 36.4 years + 12.1; BMI > 30: 25.8%). Two hundred five (91.1%) patients underwent first and/or cervical BMI > rib resection (+/- scalenectomy), and the remaining 20(8.9%)underwent rib-sparing scalenectomy. First and/or cervical rib resection was associated with longer operative time (mean = 221.7 minutes vs 154.1 minutes, P = .000), and with longer hospital stays (mean = 4.2 days vs 2.9 days, P = .000), compared with rib-sparing scalenectomy. Overall, 8 (3.6%) patients developed 10 complications in the 30-day postoperative period, 9 (90% of complications) occurred in 7 rib resection patients (87.5% of patients with complications). Furthermore, there were 10 (4.4%) patients that required return to the operating room, all of whom had rib resection (100%). Nine patients were re-admitted (14.3%), all of whom had rib resection (100%). No significant associations were found between rib resection, and these complications and return to care. Conclusion: First and/or cervical rib resection is associated with longer surgical times and hospital stays. Additionally, there may be a relationship between rib resection and post- operative complications and return to care. These data highlight the importance of pre- operative evaluation in determining the location of the brachial plexus compression to direct surgical management that reduces morbidity for patients and utilization of limited healthcare resources. Learning Objective: To consider differences in outcome following surgical decompression of nTOS with or without rib resection.