Improvement of Disability in Neurogenic Thoracic Outlet Syndrome by Robotic First Rib Resection.
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
received:
10
02
2021
revised:
13
05
2021
accepted:
14
07
2021
pubmed:
23
8
2021
medline:
1
9
2022
entrez:
22
8
2021
Statut:
ppublish
Résumé
Robotic transthoracic first rib resection (R-FRR) has advantages over traditional approaches; however, its impact on postoperative neurogenic thoracic outlet syndrome (nTOS) outcomes is unknown. Our primary objective was to determine improvement of patient-reported outcome measures (PROMs) of pain and disability after R-FRR in nTOS. Our secondary objective was to compare improvement of patient-reported pain between R-FRR and supraclavicular FRR (SC-FRR) in nTOS. We queried a prospectively maintained, single-surgeon, single-institution database for patients with nTOS undergoing R-FRR or SC-FRR with available preoperative and postoperative PROMs. PROMs included the Disability of the Arm, Hand, and Shoulder (DASH) questionnaire and visual analog scale (VAS) for pain. Cohort 1 included 37 patients (32 women) undergoing 40 R-FRRs, with an average age of 36 years. Preoperative VAS and DASH (6.0 and 64.2, respectively) improved significantly at the first (2.8 and 35.0; P < .001 for both) and second postoperative visits (1.4 and 30.2; P < .01 for both) which occurred at 2.6 and 15.3 weeks, respectively. Cohort 2 included 57 R-FRRs performed in 53 patients and 35 SC-FRRs performed in 34 patients. The R-FRR and SC-FRR groups did not significantly differ in sex, age, hand dominance, TOS laterality, or preoperative VAS. At the first postoperative visit (2.4 weeks), R-FRR was associated with lower VAS scores (P = .023) and greater VAS improvement than SC-FRR (53% and 27% decrease, respectively; P = .008). R-FRR results in significant improvement in disability and pain in nTOS and may have a greater impact on patient-reported pain than SC-FRR in the early postoperative period.
Sections du résumé
BACKGROUND
Robotic transthoracic first rib resection (R-FRR) has advantages over traditional approaches; however, its impact on postoperative neurogenic thoracic outlet syndrome (nTOS) outcomes is unknown. Our primary objective was to determine improvement of patient-reported outcome measures (PROMs) of pain and disability after R-FRR in nTOS. Our secondary objective was to compare improvement of patient-reported pain between R-FRR and supraclavicular FRR (SC-FRR) in nTOS.
METHODS
We queried a prospectively maintained, single-surgeon, single-institution database for patients with nTOS undergoing R-FRR or SC-FRR with available preoperative and postoperative PROMs. PROMs included the Disability of the Arm, Hand, and Shoulder (DASH) questionnaire and visual analog scale (VAS) for pain.
RESULTS
Cohort 1 included 37 patients (32 women) undergoing 40 R-FRRs, with an average age of 36 years. Preoperative VAS and DASH (6.0 and 64.2, respectively) improved significantly at the first (2.8 and 35.0; P < .001 for both) and second postoperative visits (1.4 and 30.2; P < .01 for both) which occurred at 2.6 and 15.3 weeks, respectively. Cohort 2 included 57 R-FRRs performed in 53 patients and 35 SC-FRRs performed in 34 patients. The R-FRR and SC-FRR groups did not significantly differ in sex, age, hand dominance, TOS laterality, or preoperative VAS. At the first postoperative visit (2.4 weeks), R-FRR was associated with lower VAS scores (P = .023) and greater VAS improvement than SC-FRR (53% and 27% decrease, respectively; P = .008).
CONCLUSIONS
R-FRR results in significant improvement in disability and pain in nTOS and may have a greater impact on patient-reported pain than SC-FRR in the early postoperative period.
Identifiants
pubmed: 34419432
pii: S0003-4975(21)01443-0
doi: 10.1016/j.athoracsur.2021.07.052
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
919-925Informations de copyright
Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.