Timing matters: Early versus delayed surgery for neurogenic thoracic outlet syndrome and its impact on reoperation and pain outcomes.

INTRODUCTION

We evaluated the impact of the timing of brachial plexus neurolysis in conjunction with rib sparing scalenectomy or first rib resection on surgical and pain-related outcomes by comparing patients who underwent surgery within 3 months of diagnosis of neurogenic thoracic outlet syndrome (early) to those operated after 3 months (delayed).

METHODS

This is a propensity-matched, multi-institutional retrospective database study. Patient demographics and surgical and pain outcomes were collected for 5 years after surgery. We used the Chi-squared test and logistic regression for analysis.

RESULTS

A total of 2593 patients were included (n=1380 early; n=1213 delayed). After 1:1 propensity matching (n=1069), there was no difference in pneumothorax, hemorrhage, infection, or re-do neurolysis procedure between the groups. Acute pain did not significantly differ between the groups. Chronic pain outcomes favored early surgery. At 6 months, the chronic pain rate was significantly lower in the early group (6.83% vs. 10.3%; OR 0.66 [0.50-0.88]; p<0.005), and this trend persisted through 5 years (14.5% vs. 22.36%; OR 0.65 [0.54-0.78]; p<0.0001). The rate of myalgia was also lower in the early cohort at 3 months (1.03% vs. 2.81%; OR 0.37 [0.19-0.73]; p<0.005), and this trend persisted through 5 years (6.83% vs. 11.79%; OR 0.58 [0.44-0.76]; p<0.0001).

CONCLUSION

Early surgery within 3 months of presentation for patients with neurogenic thoracic outlet syndrome is associated with significantly reduced long-term rates of chronic pain and myalgia. These findings support early surgical intervention to optimize pain-related outcomes. Our results should be interpreted by considering the variable symptom duration prior to diagnosis, as this may affect the observed benefit of early surgery.