A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome

Megan S. Orlando, Kendall C. Likes, Serene Mirza, Yue Cao, Anne Cohen, Ying Wei Lum, Thomas Reifsnyder, Julie A. Freischlag

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background Our aim was to evaluate the outcomes of patients who underwent first rib resection (FRR) for all 3 forms of thoracic outlet syndrome (TOS) during a period of 10 years. Study Design Patients treated with FRR from August 2003 through July 2013 were retrospectively reviewed using a prospectively maintained database. Results Five hundred and thirty-eight patients underwent 594 FRRs for indications of neurogenic (n = 308 [52%]), venous (n = 261 [44%]), and arterial (n = 25 [4%]) TOS. Fifty-six (9.4%) patients had bilateral FRR. Fifty-two (8.8%) patients had cervical ribs. Three hundred and ninety-eight (67%) FRRs were performed on female patients, with a mean age of 33 years (range 10 to 71 years). Three hundred and forty (57%) were right-sided procedures. Seventy-five children (aged 18 years or younger) underwent FRRs; 25 during the first 5 years and 50 during the second 5 years. When comparing the second 5-year period with the first 5-year period, more patients had venous TOS (48% vs 37%; p < 0.02); fewer patients had neurogenic TOS (48% vs 58%; p < 0.05), and improved or fully resolved symptoms increased from 93% to 96%. Complications included 2 vein injuries, 2 hemothoraces, 4 hematomas, 138 pneumothoraces (23%), and 8 (1.3%) wound infections. Mean length of stay was 1 day. Conclusions Excellent results were seen in this surgical series of neurogenic, venous, and arterial TOS due to appropriate selection of neurogenic patients, use of a standard protocol for venous patients, and expedient intervention in arterial patients. There is an increasing role for surgical intervention in children.

Original languageEnglish (US)
Pages (from-to)934-939
Number of pages6
JournalJournal of the American College of Surgeons
Volume220
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

Fingerprint

Thoracic Outlet Syndrome
Ribs
Cervical Rib
Hemothorax
Pneumothorax
Wound Infection
Hematoma
Patient Selection
Veins
Length of Stay
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome. / Orlando, Megan S.; Likes, Kendall C.; Mirza, Serene; Cao, Yue; Cohen, Anne; Lum, Ying Wei; Reifsnyder, Thomas; Freischlag, Julie A.

In: Journal of the American College of Surgeons, Vol. 220, No. 5, 01.05.2015, p. 934-939.

Research output: Contribution to journalArticle

Orlando, MS, Likes, KC, Mirza, S, Cao, Y, Cohen, A, Lum, YW, Reifsnyder, T & Freischlag, JA 2015, 'A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome', Journal of the American College of Surgeons, vol. 220, no. 5, pp. 934-939. https://doi.org/10.1016/j.jamcollsurg.2014.12.046
Orlando, Megan S. ; Likes, Kendall C. ; Mirza, Serene ; Cao, Yue ; Cohen, Anne ; Lum, Ying Wei ; Reifsnyder, Thomas ; Freischlag, Julie A. / A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome. In: Journal of the American College of Surgeons. 2015 ; Vol. 220, No. 5. pp. 934-939.
@article{dc09ab70ed8a486398893e1290eed6d6,
title = "A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome",
abstract = "Background Our aim was to evaluate the outcomes of patients who underwent first rib resection (FRR) for all 3 forms of thoracic outlet syndrome (TOS) during a period of 10 years. Study Design Patients treated with FRR from August 2003 through July 2013 were retrospectively reviewed using a prospectively maintained database. Results Five hundred and thirty-eight patients underwent 594 FRRs for indications of neurogenic (n = 308 [52{\%}]), venous (n = 261 [44{\%}]), and arterial (n = 25 [4{\%}]) TOS. Fifty-six (9.4{\%}) patients had bilateral FRR. Fifty-two (8.8{\%}) patients had cervical ribs. Three hundred and ninety-eight (67{\%}) FRRs were performed on female patients, with a mean age of 33 years (range 10 to 71 years). Three hundred and forty (57{\%}) were right-sided procedures. Seventy-five children (aged 18 years or younger) underwent FRRs; 25 during the first 5 years and 50 during the second 5 years. When comparing the second 5-year period with the first 5-year period, more patients had venous TOS (48{\%} vs 37{\%}; p < 0.02); fewer patients had neurogenic TOS (48{\%} vs 58{\%}; p < 0.05), and improved or fully resolved symptoms increased from 93{\%} to 96{\%}. Complications included 2 vein injuries, 2 hemothoraces, 4 hematomas, 138 pneumothoraces (23{\%}), and 8 (1.3{\%}) wound infections. Mean length of stay was 1 day. Conclusions Excellent results were seen in this surgical series of neurogenic, venous, and arterial TOS due to appropriate selection of neurogenic patients, use of a standard protocol for venous patients, and expedient intervention in arterial patients. There is an increasing role for surgical intervention in children.",
author = "Orlando, {Megan S.} and Likes, {Kendall C.} and Serene Mirza and Yue Cao and Anne Cohen and Lum, {Ying Wei} and Thomas Reifsnyder and Freischlag, {Julie A.}",
year = "2015",
month = "5",
day = "1",
doi = "10.1016/j.jamcollsurg.2014.12.046",
language = "English (US)",
volume = "220",
pages = "934--939",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome

AU - Orlando, Megan S.

AU - Likes, Kendall C.

AU - Mirza, Serene

AU - Cao, Yue

AU - Cohen, Anne

AU - Lum, Ying Wei

AU - Reifsnyder, Thomas

AU - Freischlag, Julie A.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background Our aim was to evaluate the outcomes of patients who underwent first rib resection (FRR) for all 3 forms of thoracic outlet syndrome (TOS) during a period of 10 years. Study Design Patients treated with FRR from August 2003 through July 2013 were retrospectively reviewed using a prospectively maintained database. Results Five hundred and thirty-eight patients underwent 594 FRRs for indications of neurogenic (n = 308 [52%]), venous (n = 261 [44%]), and arterial (n = 25 [4%]) TOS. Fifty-six (9.4%) patients had bilateral FRR. Fifty-two (8.8%) patients had cervical ribs. Three hundred and ninety-eight (67%) FRRs were performed on female patients, with a mean age of 33 years (range 10 to 71 years). Three hundred and forty (57%) were right-sided procedures. Seventy-five children (aged 18 years or younger) underwent FRRs; 25 during the first 5 years and 50 during the second 5 years. When comparing the second 5-year period with the first 5-year period, more patients had venous TOS (48% vs 37%; p < 0.02); fewer patients had neurogenic TOS (48% vs 58%; p < 0.05), and improved or fully resolved symptoms increased from 93% to 96%. Complications included 2 vein injuries, 2 hemothoraces, 4 hematomas, 138 pneumothoraces (23%), and 8 (1.3%) wound infections. Mean length of stay was 1 day. Conclusions Excellent results were seen in this surgical series of neurogenic, venous, and arterial TOS due to appropriate selection of neurogenic patients, use of a standard protocol for venous patients, and expedient intervention in arterial patients. There is an increasing role for surgical intervention in children.

AB - Background Our aim was to evaluate the outcomes of patients who underwent first rib resection (FRR) for all 3 forms of thoracic outlet syndrome (TOS) during a period of 10 years. Study Design Patients treated with FRR from August 2003 through July 2013 were retrospectively reviewed using a prospectively maintained database. Results Five hundred and thirty-eight patients underwent 594 FRRs for indications of neurogenic (n = 308 [52%]), venous (n = 261 [44%]), and arterial (n = 25 [4%]) TOS. Fifty-six (9.4%) patients had bilateral FRR. Fifty-two (8.8%) patients had cervical ribs. Three hundred and ninety-eight (67%) FRRs were performed on female patients, with a mean age of 33 years (range 10 to 71 years). Three hundred and forty (57%) were right-sided procedures. Seventy-five children (aged 18 years or younger) underwent FRRs; 25 during the first 5 years and 50 during the second 5 years. When comparing the second 5-year period with the first 5-year period, more patients had venous TOS (48% vs 37%; p < 0.02); fewer patients had neurogenic TOS (48% vs 58%; p < 0.05), and improved or fully resolved symptoms increased from 93% to 96%. Complications included 2 vein injuries, 2 hemothoraces, 4 hematomas, 138 pneumothoraces (23%), and 8 (1.3%) wound infections. Mean length of stay was 1 day. Conclusions Excellent results were seen in this surgical series of neurogenic, venous, and arterial TOS due to appropriate selection of neurogenic patients, use of a standard protocol for venous patients, and expedient intervention in arterial patients. There is an increasing role for surgical intervention in children.

UR - http://www.scopus.com/inward/record.url?scp=84928432567&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84928432567&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2014.12.046

DO - 10.1016/j.jamcollsurg.2014.12.046

M3 - Article

VL - 220

SP - 934

EP - 939

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 5

ER -