The influence of choice of therapy on quality of life in patients with neurogenic thoracic outlet syndrome.
OBJECTIVE
We aimed to compare quality of life (QoL) after surgical decompression of the thoracic outlet versus non-operative therapy in patients with neurogenic thoracic outlet syndrome (N-TOS).


METHODS
We retrospectively identified 46 patients, diagnosed with N-TOS between 1999 and 2008. Twenty-four operated and 22 conservatively treated patients were sent questionnaires on their current symptoms and QoL. A matched control group (n = 24) of healthy individuals was selected for QoL comparison. Statistics were performed with linear and logistic regression analysis.


RESULTS
ANOVA revealed a significant QoL difference between the three groups (p = 0.001). Separate analysis between groups demonstrated that all patients with N-TOS-like symptoms have a lower QoL than healthy controls (p = 0.001 resp. p  < or =  0.000). No difference was found between conservatively and surgically treated patients (p = 0.26). EQ-5D response rate was 83%. Of the 24 surgically treated patients, 15 would choose surgery again in a similar situation, although 4 did not benefit in terms of symptom reduction. Symptom relief and VAS pain scores in the conservatively and surgically treated patients did not show significant differences (p = 0.95 resp. p = 0.40).


CONCLUSIONS
All patients with N-TOS have a significantly decreased QoL compared with healthy individuals, regardless of the type of therapy they received. In this small study, surgical decompression fails to improve QoL in patients with N-TOS to the level measured in the healthy control group, despite symptom reduction consistent with previous reports. Variables significantly associated with outcome were duration of symptoms and localisation (variables included in the prediction model: age, sex, duration of symptoms, presence of paraesthesias, localisation, Adson's, Wright's and Roos' test, history of trauma, cervical arthrosis). In the perspective of QoL, the benefit of decompressive surgery is questionable. Improving patient selection seems imperative in order to achieve better results in our surgically treated patients.
Bosma
J
J
Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. j.bosma@olvg.nl
Van Engeland
M I A
MI
Leijdekkers
V J
VJ
Vahl
A C
AC
Wisselink
W
W
D000328:Adult; D002755:Choice Behavior; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D059408:Pain Management; D011788:Quality of Life; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D011795:Surveys and Questionnaires; D013901:Thoracic Outlet Syndrome / Q000628:therapy*; D016896:Treatment Outcome