Outcomes after surgery for thoracic outlet syndrome.
OBJECTIVE
This study determined whether there is an association between psychological and socioeconomic characteristics and the long-term outcome of operative treatment for patients with sensory neurogenic thoracic outlet syndrome (N-TOS).


METHODS
Clinical records, preoperative psychological testing results, and long-term follow-up questionnaire data were reviewed for consecutive patients who underwent surgery for N-TOS from 1990 to 1999. Multivariate logistic regression models were developed as a means of identifying independent risk factors for postoperative disability.


RESULTS
Operative decompression of the brachial plexus via a supraclavicular approach was performed for upper extremity pain and paresthesia with no mortality and minimal morbidity in 170 patients. After an average follow-up period of 47 months, 65% of patients reported improved symptoms, and 64% of patients were satisfied with their operative outcome. However, 35% of patients remained on medication, and 18% of patients were disabled. Preoperative factors associated with persistent disability include major depression (odds ratio [OR], 15.7; P =.02), not being married (OR, 7.9; P =.04), and having less than a high school education (OR, 8.1; P =.09).


CONCLUSIONS
Operative decompression was beneficial for most patients. Psychological and social factors, including depression, marital status, and education, are associated with self-reported disability. The impact of the preoperative treatment of depression on the outcome of TOS decompression should be studied prospectively.
Axelrod
D A
DA
Department of Surgery, University of Michigan Hospitals, Ann Arbor, USA.
Proctor
M C
MC
Geisser
M E
ME
Roth
R S
RS
Greenfield
L J
LJ
D000328:Adult; D001917:Brachial Plexus / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D017060:Patient Satisfaction; D011788:Quality of Life; D016059:Range of Motion, Articular; D012042:Registries; D012720:Severity of Illness Index; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome