title: Predictors of outcome following endoscopic thoracic sympathectomy.
abstract: BACKGROUND
  Endoscopic thoracic sympathectomy (ETS) provides definitive management for primary focal hyperhidrosis and facial blushing. These conditions are debilitating and not uncommon, but many clinicians avoid ETS due to the risk of complications, particularly compensatory sweating (CS). This retrospective cohort study aimed to evaluate the degree of symptom resolution, patient satisfaction and adverse reactions after ETS and to identify subgroups of patients more likely to achieve a satisfactory outcome.
  
  
  METHODS
  From 2004 to 2010, 210 patients underwent ETS performed by a single surgeon. These patients responded to a questionnaire regarding levels of satisfaction, symptom resolution and complications encountered, particularly CS.
  
  
  RESULTS
  Palmar hyperhidrosis (97%) and scalp/facial hyperhidrosis (93%) demonstrated greater degrees of symptom resolution than axillary hyperhidrosis (71%) and facial blushing (71%) (P < 0.001). Rates of severe CS were lowest in patients with palmar hyperhidrosis (8%) and highest in patients with axillary (26%) and scalp/facial (44.5%) hyperhidrosis (P = 0.0003). The probability of experiencing no CS was highest at young ages and decreased with age (P = 0.0006). Satisfaction rates also fell as age increased (P = 0.004). Satisfaction rates were highest in patients with palmar (90%) and lowest in patients with scalp/facial (52%) hyperhidrosis (P < 0.02).
  
  
  CONCLUSIONS
  Patient satisfaction following ETS is highest among younger patients and those undergoing the procedure for palmar hyperhidrosis. Dissatisfaction arises from failure to achieve the desired aim as well as the development of severe CS, which is more common in older patients and those undergoing ETS for axillary and scalp/facial hyperhidrosis.
authors: Department of Vascular Surgery, Monash Medical Centre, Clayton, Victoria, Australia.
authors: David
authors: D
authors: Bell
authors: Justin
authors: J
authors: Jedynak
authors: Roger
authors: R
authors: Bell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005483:Flushing / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013562:Sympathectomy / Q000379:methods*; D013900:Thoracic Nerves / Q000601:surgery*; D013906:Thoracoscopy; D016896:Treatment Outcome; D055815:Young Adult
keywords: blushing; hyperhidrosis; sweating; sympathectomy; thoracoscopic surgery