Chang David C, Lidor Anne O, Matsen Susanna L, Freischlag Julie A
Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
Ann Vasc Surg. 2007 Sep;21(5):564-70. doi: 10.1016/j.avsg.2007.03.025. Epub 2007 Jun 21.
While brachial plexus injury has been described as the most common complication following thoracic outlet syndrome (TOS) operation and case series have been reported, the exact incidence rate has not been described. We conducted a retrospective analysis of 5 years (1999-2003) of the Nationwide Inpatient Sample database. Neurogenic TOS patients, rib resections, brachial plexus injuries, and vascular injuries are identified by ICD-9 diagnosis codes or procedure codes. A total of 2,016 TOS operations were identified, ranging 317-468 per year, in this database. Mean age was 37.3 years, with 1,409 (70.2%) women and 1,270 (63.0%) Caucasians. These patients were treated in a total of 392 hospitals, with an average volume of 1.03 cases per hospital per year (range 0-114). Their mean hospital length of stay was 2.51 days (median 2), with a mean total hospital charge of $16,160 in inflation-adjusted year 2005 dollars (median $11,824). The majority (1,421, or 70.5%) was treated at a teaching hospital. There were 12 brachial plexus injuries (0.60%) and 35 vascular injuries (1.74%). The rate of vascular injuries was significantly lower among teaching hospitals (1.34% vs. 2.69%, P = 0.03) and in women (1.35% vs. 2.67%, P = 0.03). Vascular injury patients had significantly longer lengths of stay (7.7 vs. 2.4 days, P < 0.001) and higher total hospital charges ($53,373 vs. $15,507, P < 0.001), while no such difference was observed among brachial plexus injury patients. On hospital discharge, brachial plexus injury following rib resection for TOS occurs in <1% of cases, while vascular injuries occur in 1-2% of cases. The low complication rates suggest that the operation can be performed safely in all patients, especially at teaching hospitals, which had significantly lower rates of vascular injuries, shorter hospital lengths of stay, and lower hospital charges. The low incidence rates of these traditional clinical measures of outcome in TOS patients suggest that the appropriate measure for TOS patient outcome would be patient-reported quality of life or functional outcomes.
