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

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.