Patient Reported Long-Term Quality of Life and Symptom Resolution after First Rib Resection and Anterior Scalenectomy.

Abstract

The aim of this study is to evaluate patient reported long-term outcomes of neurogenic and venous thoracic outlet syndrome patients (nTOS and vTOS, respectively) undergoing first rib resection and anterior scalenectomy (FRRAS). Single institution, retrospective chart review from 2015-2025 was completed after obtaining institutional review board approval. Baseline demographic and clinical data were collected for patients who underwent surgery at least one year prior. A 5-question quality of life (QOL) survey was provided to patients via phone call or the electronic health record. Descriptive statistics including number (%) of categorical factors or median and inner-quartile range [IQR] of continuous factors were reported. Differences between TOS subtypes were assessed using Fisher's exact test (categorical) or rank sum tests (continuous). Of the 204 patients who underwent FRRAS, 104 completed our survey (57/114 nTOS and 47/90 vTOS). nTOS patients had significantly longer preoperative symptom duration (median [IQR] 24 [12, 60] months vs 2 [1, 10] months for vTOS, p < 0.001) with no other differences between groups (see table 1). In nTOS, most patients (43/57, 75.4%) indicated improved QOL, regardless of surgical approach. While most patients did not have recurrent symptoms (32/57, 56.1%), those that did were more likely to be older (median age 39 [35, 46] years vs 27 [17, 39] years, p 0.003). 30/57 (52.6%) patients reported ongoing paresthesias, though 47/57 (82.5%) did not require chronic medications. Patients requiring chronic medication were more likely to have undergone reoperative surgery (30% vs 4.3%, p=0.033). Similarly, in vTOS, most patients (41/47, 87.2%) reported improved QOL, regardless of surgical approach. Most veins (45/47, 95.7%) were patent at time of follow-up and did not affect outcome. Younger patients were more likely to have improvement (median 31 [22-41] years vs 47 [44, 50] years, p=0.015). Patients with recurrent symptoms, paresthesias, chronic medication use, or ongoing PT/OT needs were significantly older (median age 49 [43-53] vs 30 [21-39] years, p < 0.001; 42 [31-48] vs 30 [20-41] years, p = 0.027; 52 [50-55] vs 32 [22-41] years, p = 0.007 and 43 [41-51] vs 31 [21-41] years, p = 0.014). Patient reported long-term outcomes are favorable for nTOS and vTOS patients undergoing FRRAS. Our study highlights differences in long-term QOL by age, with younger patients having longer-term symptom free experiences. While a small proportion of patients have recurrent symptoms, most report improved QOL.