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American Association for Hand Surgery

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Patient Characteristics of Those Presenting for Thoracic Outlet Syndrome Surgical Treatment
Tariq Ziad Issa, BA, Northwestern University, Chicago, IL, Ivy Chen, MS, Boston University, Boston, MA, Puneet Gupta, BS, George Washington University, Washington, DC, DC, Fernando Herrera, MD, Division of Plastic Surgery, Medical University of South Carolina, Charleston, SC and Brian A Mailey, MD, Southern Illinois University School of Medicine, Springfield, IL


Introduction
The operative approach for thoracic outlet syndrome (TOS) varies in the United States. Although many other clinical syndromes and disorders are associated with predictable risk factors and typical features, common associations with thoracic outlet syndrome have yet to be described. We sought to identify patient characteristics presenting for different TOS surgical interventions.
Materials and Methods
Patients treated for TOS between 2016 - 2018 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Patient cohorts were stratified by type of operative intervention (transthoracic rib resection vs. supraclavicular scalene division with or without rib resection). We excluded cases from review if there were less than 10 identified cases for a given primary CPT9 code.
Results
1023 patients were identified in this cohort. The average age of patients was 36.4. 61.9% of patients were female and 88% were White. Patients undergoing tenotomy were generally the oldest (40.1 years) while those undergoing excision of a cervical rib with a sympathectomy were much younger (32.6 years). When surgical operations were grouped into transthoracic rib resection vs. supraclavicular scalene division, no differences existed in in age (36.2 ± 12.9 vs 36.3 ± 7.2 years), BMI (27.2 ± 5.8 vs 27.5 ± 7.1) or other demographics. Patient disposition was also the same across operative types detailed as an ASA class of 2.02 ± 0.65 and 2.04 ± 0.55 vs 27.5 for transthoracic rib resection and supraclavicular scalene division, respectively. The most common co-morbidities among patients in this cohort were smoking history (15.7%), medically treated hypertension (12.3%), and bleeding history (8.2%).
Conclusions
White, female patients who were overweight represented the majority of patients presenting for surgically treated TOS. No significant differences exist in patients undergoing a surgical approach characterized by transthoracic rib resection or a supraclavicular scalene division with or without rib resection. Because of similar patient dispositions and characteristics, along with similar complication rates, patient characteristics may not be an important factor in guiding surgical approach. Approach to TOS surgery should be provider-dependent based on training, expertise, and the individual patient's disease course.


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