Functional Short-Term Outcomes After Transaxillary First Rib Resection in Thoracic Outlet Syndrome

Thoracic outlet syndrome is a disabling condition in which surgical treatment is considered for patients after failure of physical therapy or in the presence of vascular complications. The aim of this study was to evaluate the outcomes of first rib resection via the transaxillary approach using patient-reported outcomes measures with Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Short Form 36 (SF-36), and to identify potential predictors of surgical success.

We conducted a single-center prospective study over 1 year. All patients undergoing surgery for thoracic outlet syndrome were asked to complete QuickDASH and SF-36 questionnaires preoperatively and at last follow-up.

Eighty-eight patients were included, with a mean age of 38.5 ± 10 years; 65 (73.8%) were women. All patients underwent first rib resection via the transaxillary approach, associated with pectoralis minor section in 46 cases (52.2%). The mean duration of follow-up was 92.2 ± 56 days postoperatively. The mean preoperative QuickDASH score was 61 ± 1.8 which improved significantly to 44.3 ± 2.04 postoperatively (P < 0.05). Significant improvement was reported in all SF-36 domains except for physical functioning. On multivariate analysis, female sex was identified as an independent predictor factor of favorable surgical outcomes (Relative Risk [RR] 1.6291 (Interval Confidence [IC] 95% 1.00-2.63) P = 0.046).

At 3 months follow-up, transaxillary first ribs resection results in functional improvement in patients with thoracic outlet syndrome, with female sex identified as an independent predictor of better outcomes.