Quality of life and work status in patients treated for neurogenic thoracic outlet syndrome via the microsurgical supraclavicular approach - an observational study.

Abstract

Objective: Neurogenic thoracic outlet syndrome (nTOS) is a diagnostic and therapeutic challenge. Recently, consensus statements were developed within the neurosurgical community to improve diagnosis, classification and therapy. However, a standardized outcome assessment according to a validated Quality of life (QoL) questionnaire and has never been performed in patients surgically treated according to the consented recommendations.

Objective: To provide systematic information about QoL based on a validated questionnaire and work status in patients surgically treated for nTOS via the supraclavicular approach without routine first rib resection.

Methods: Patients surgically treated for nTOS between January 1, 2015, and June 30, 2023 were included. A systematic outcome evaluation using the EQ-5D-5L and a structured interview was performed.

Results: The final analysis included 18 patients (median age 39.5 years [45-34], 71% female), of which 94.4% showed a benefit from surgery after a median follow-up (FU) of 1.7 years (IQR 0,7-3). Pain scores on the numerical rating scale (NRS from 0 to 10) significantly improved from 8 (IQR 9-8) to 4 (IQR 5-4) at FU (p < 0.001). The individual health-related QoL on a scale from 0 to 100 was rated with a median of 65 (IQR 50-75) before surgery and 85 (IQR 80-95) at FU (p < 0.001). Five dimensions (mobility/self-care/usual activities/pain/anxiety) were rated on scales from 1 (no problems) to 5 (inability to perform tasks) resulting in median values of 3/3/4/3/3 before surgery and of 2/2/2/2/1 at FU. Patient absence from work due to sick leave decreased from 44% to 18% at FU (p = 0.02).

Conclusion: Consensus-based patient management in nTOS led to a significant benefit in terms of pain relief and individual health-related QoL. After surgery, return to work increased significantly.