Outcomes after surgery for thoracic outlet syndrome

Purpose: This study determined whether there is an association between psyc hological and socioeconomic characteristics and the long-term outcome of op erative treatment for patients with sensory neurogenic thoracic outlet synd rome (N-TOS). Methods: Clinical records, preoperative psychological testing results, and long-term follow-up questionnaire data were reviewed for consecutive patien ts who underwent surgery for N-TOS from 1990 to 1999. Multivariate logistic regression models were developed as a means of identifying independent ris k factors for postoperative disability. Results: Operative decompression of the brachial plexus via a supraclavicul ar approach was performed for upper extremity pain and paresthesia with no mortality and minimal morbidity in 170 patients. After an average follow-up period of 47 months, 65% of patients reported improved symptoms, and 64% o f patients were satisfied with their operative outcome. However, 35% of pat ients remained on medication, and 18% of patients were disabled. Preoperati ve factors associated with persistent disability include major depression ( odds ratio [OR], 15.7; P =.02), not being married (OR, 7.9; P =.04), and ha ving less than a high school education (OR, 8.1; P =.09). Conclusion: Operative decompression was beneficial for most patients. Psych ological and social factors, including depression, marital status, and educ ation, are associated with self-reported disability. The impact of the preo perative treatment of depression on the outcome of TOS decompression should be studied prospectively.