Postoperative Outcomes In Thoracic Outlet Decompression For Acute Versus Chronic Venous Thoracic Outlet Syndrome
Scott Chapman, MD, Mikayla Lowenkamp, BS, Michael Singh, MD, Mohammad Eslami, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Objectives – Venous Thoracic Outlet Syndrome (VTOS) is a rare disorder that commonly occurs in young athletes and working adults. Published reports have demonstrated improved outcomes in patients presenting in the acute stage as defined as less than two weeks of symptoms. Our objectives were to compare symptomatic improvement in those undergoing thoracic outlet decompression surgery for acute presentations versus those who presented with chronic symptoms. Additionally, we identified predictors of failure in symptom resolution following operative decompression.
Methods – This study consisted of a retrospective chart review of patients who underwent operative decompression for VTOS at the University of Pittsburgh Medical Center from 2013-2017. We examined baseline characteristics, comorbidities, presenting symptoms, interventions performed and postoperative clinical outcomes. Patients were characterized as acute, subacute or chronic presentators. Those with symptom onset less than 14 days of presentation were considered acute, those with symptoms from 14 days to less than 3 months were considered subacute and those with symptoms lasting longer than 3 months prior to presentation were characterized as chronic. Our outcome of interest was return to baseline functional status as defined by returning to sports or work.
Results – A total of 51 patients underwent operative decompression for VTOS. 23 patients presented acutely, 7 patients presented subacutely, and 21 presented with chronic symptoms. Of these 50 patients, 5 had persistent symptoms despite undergoing operative decompression. Three were acute, one was subacute, and one was chronic. The Fisher’s exact was 0.540 indicating the proportion of patients returning to baseline functional status were similar among the three presentation groups. The effect of gender on return to functional status, though moderate in magnitude, trended towards significant (HR =0.630, P=0.113). A multivariate Cox proportional hazards model was attempted however, small sample size greatly limited the power of the study and we were unable to identify any risk factors.
Conclusions –Those presenting with symptoms of VTOS for less than 14 days had similar outcomes in symptom resolution following operative decompression when compared with those who presented with subacute (14 days – 3 months) or chronic (>3 months) symptoms. A national database may be beneficial to study risk factors associated with symptom persistence after surgical decompression in this patient population.
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