Influence of body mass index on functional and surgical outcomes in transaxillary thoracic outlet decompression for neurogenic thoracic outlet syndrome

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE Journal of Vascular Surgery Pub Date : 2025-06-01 Epub Date: 2025-02-02 DOI:10.1016/j.jvs.2025.01.208

Stijn B.J. Teijink BSc , Maren R.E. Snoek MD , Yves Y. Dujardin MD , Jens Goeteyn MD, PhD , Marc R.H.M. van Sambeek MD, PhD , Bart F.L. van Nuenen MD, PhD , Niels Pesser MD, PhD , Joep A.W. Teijink MD, PhD

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Abstract

Objective

Despite an increase in prevalence of obesity over the last decades, few studies examine the influence of body mass index (BMI) on the outcome of thoracic outlet decompression (TOD) for neurogenic thoracic outlet syndrome (NTOS). However, it is important to understand the safety and efficacy of this procedure in patients with elevated BMI. This study aimed to determine the influence of BMI on surgical and functional outcomes following transaxillary TOD in patients with NTOS.

Methods

We performed a retrospective review of a prospectively collected database with patients who underwent transaxillary TOD for NTOS from July 2016 to January 2023. Patients were categorized into three groups according to their BMI, normal weight (<25.0 kg/m²), overweight (25.0-30.0 kg/m²), and obesity (>30.0 kg/m²). Primary outcomes were peri- and postoperative complications, such as hematoma, scapula alata, Horner syndrome, and wound infections. Secondary outcomes were length of stay, drain placement duration, pleural catheter placement duration, and functional outcome. Functional outcome was evaluated by using the Derkash classification; Disability of the Arm, Shoulder, and Hand questionnaire; and Cervical Brachial Symptom questionnaire scores up to 24 months of follow-up.

Results

The surgical results of 346 patients undergoing NTOS were analyzed. Of these patients, 191 (55.2%) were classified as normal weight, 98 (28.3%) as overweight, and 57 (16.5%) as obese. No significant difference in complication rates between BMI groups was found (P = .672). All groups had significant postoperative improvements in Disability of the Arm, Shoulder, and Hand questionnaire and Cervical Brachial Symptom Questionnaire scores (P < .001). There were no significant differences in functional outcomes between the three BMI groups.

Conclusions

The transaxillary approach for surgical treatment of NTOS can be used safely and effectively in patients of all BMI groups.

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体重指数对经腋窝胸廓减压治疗神经源性胸廓综合征的功能和手术效果的影响。

导言：尽管在过去的几十年里，肥胖的患病率有所增加，但很少有研究检查体重指数（BMI）对神经性胸廓出口综合征（NTOS）胸廓出口减压（TOD）结果的影响。然而，重要的是要了解该手术对BMI升高患者的安全性和有效性。本研究旨在确定BMI对NTOS患者经腋窝胸廓出口减压术（TA-TOD）后手术和功能结局的影响。方法：我们对2016年7月至2023年1月期间前瞻性收集的因NTOS接受TA-TOD治疗的患者数据库进行回顾性分析。根据BMI将患者分为正常体重（< 25.0 kg/m2）、超重（25.0 ~ 30.0 kg/m2）、肥胖（> ~ 30.0 kg/m2） 3组。主要结局是手术前后的并发症，如血肿、肩胛骨畸形、霍纳综合征和伤口感染。次要结果为住院时间（LOS）、引流管放置时间、胸膜导管放置时间和功能结果。通过使用Derkash分类、臂肩和手残疾问卷（DASH）和颈肱症状问卷（CBSQ）评分来评估功能结局，随访时间长达24个月。结果：对346例NTOS患者的手术效果进行分析。其中191例（55.2%）体重正常，98例（28.3%）超重，57例（16.5%）肥胖。BMI组间并发症发生率差异无统计学意义（p = 0.672）。结论：经腋窝入路手术治疗NTOS可安全有效地应用于所有BMI组患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.