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Early Postoperative Complications and Healthcare Utilization Following Thoracic Outlet Decompression for Thoracic Outlet Syndrome
Talha Maqbool, BHSc1; Christine B. Novak, PT, PhD1; Timothy Jackson, MD, MPH, FRCSC2; Heather Baltzer, MSc, MD; FRCSC2
1University of Toronto, Toronto, ON, Canada, 2Toronto Western Hospital, Toronto, ON, Canada
Introduction: Surgical intervention for Thoracic Outlet Syndrome (TOS) follows failure of conservative management and involves resection of the anterior scalene +/- resection of the cervical rib. We reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for all cases of TOS and hypothesized that rib resection would be associated with increased 30-day complications and healthcare utilization.
Methods: The NSQIP database for 2005-2013 was queried to identify patients with TOS based on ICD-9-CM code 353.0. The TOS patients were separated into two groups based on whether they were treated with cervical rib resection. Normality was assessed and Mann-Whitney U tests were conducted to compare differences in outcomes between groups (p<0.05 significance).
Results: 312 patients were identified: males=34.6%; average age=37.02y (+/-12.5); BMI>/= 30=26.9%. There were no mortalities, but 12 (3.8%) patients had early complications, including 10 (3.2%) surgical complications, 7 (2.2%) major complications, 7 (2.2%) adverse events, and 1 (0.32%) infection. In total, 205 (65.7%) patients had cervical rib resection, of which 116 (37.2% of all patients) also had anterior scalenectomy. Of the 12 patients with early complications, 7 (58.3%) had cervical rib resection; of the 10 patients with surgical complications, 7 (70%) had rib resection; of the 7 patients with major complications, 5 (71.4%) had rib resection; and of the 7 patients with adverse events, 5 had rib resection (71.4%). The only patient with infection also had rib resection. However, these complication and adverse event rates did not achieve statistical significance. However, rib resection was associated with significantly longer hospital stays (average=4.22 days) than no rib resection (average=2.85 days) (p=0.000), and as well with longer operative-time than no rib resection (average=221.66 minutes vs. 169.38 minutes, p=0.000). Lastly, there were 7 patients that required re-operation, 5 (71.4%) of whom had rib resection. Furthermore, 10 were re-admitted (n=95 reported), out of whom 9 (90%) had rib resection.
Conclusions: Early postoperative complications are relatively rare after decompression of the thoracic outlet. There may be a relationship between cervical rib resection, and complications and increased health care utilization. These data suggest that, when appropriate, cervical rib resection should be avoided to reduce the risk of early postoperative complications, thus highlighting the importance of preoperative evaluation in determining the location of brachial plexus compression to direct surgical management that reduces morbidity for patients and utilization of limited healthcare resource.
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