Quality-of-life scores in neurogenic thoracic outlet syndrome patients undergoing first rib resection and scalenectomy

Danielle H. Rochlin, Marta M. Gilson, Kendall C. Likes, Emma Graf, Nancy Ford, Paul J. Christo, Julie A. Freischlag

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Objective: First rib resection and scalenectomy (FRRS) has been shown to improve short-term quality of life (QOL) in the treatment of neurogenic thoracic outlet syndrome (NTOS). Long-term benefits are not well studied but are believed to decrease over time. Our objective was to evaluate long-term NTOS outcomes using validated QOL instruments. Methods: We identified 162 NTOS patients aged ≥18 years treated by FRRS from 2003 to 2010 after they had not responded to conservative management. The patients were mailed three surveys to assess QOL (Short-Form 12 [SF-12], Brief Pain Inventory [BPI], and Cervical Brachial Symptom Questionnaire [CBSQ]), with five total outcomes measures including the SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS), BPI severity, BPI interference, and CBSQ score. Demographic and clinical data were extracted from patient records. Each FRRS was categorized based on postoperative clinical assessment as successful, failed, or leading to recurrent symptoms. Results: Survey yield was 53.7% (n = 87) with mean follow-up of 44.7 months (range, 12.4-91.9 months). There was no significant difference in QOL scores associated with long-term compared with short-term follow-up. Significantly poorer scores on all instruments were associated with comorbid chronic pain syndromes, opioid use, and unfavorable clinical assessment (P <.05). Significantly poorer scores on select instruments were associated with smoking (BPI both; P <.02), age ≥40 years (SF-12 PCS, BPI interference, CBSQ; P <.03), neck and/or shoulder disease (SF-12 both, BPI both; P <.01), postoperative injections (BPI both, CBSQ; P <.05), and complications (SF-12 PCS, CBSQ; P <.05). A positive preoperative scalene block was not significantly associated with long-term QOL scores. Conclusions: The QOL after FRRS shows no significant difference with longer follow-up. Clinical assessment reflects patient-reported outcomes and can gauge postoperative improvement. Patient factors, particularly comorbidities and opioid use, are more predictive of long-term QOL than is preoperative scalene block and should also be considered when selecting patients for surgical intervention.

Original languageEnglish (US)
Pages (from-to)436-443
Number of pages8
JournalJournal of Vascular Surgery
Volume57
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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    Rochlin, D. H., Gilson, M. M., Likes, K. C., Graf, E., Ford, N., Christo, P. J., & Freischlag, J. A. (2013). Quality-of-life scores in neurogenic thoracic outlet syndrome patients undergoing first rib resection and scalenectomy. Journal of Vascular Surgery, 57(2), 436-443. https://doi.org/10.1016/j.jvs.2012.08.112