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Development and validation of a prediction model for outcomes after transaxillary first rib resection for neurogenic thoracic outlet syndrome following strict Society for Vascular Surgery diagnostic criteria.
Ochuba, Arinze J; Mallela, Deepthi P; Feghali, James; Lubelski, Daniel; Belzberg, Allan J; Hicks, Caitlin W; Abularrage, Christopher J; Lum, Ying Wei.
Afiliação
  • Ochuba AJ; The Johns Hopkins University School of Medicine, Baltimore, MD.
  • Mallela DP; Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; The Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, OH.
  • Feghali J; Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
  • Lubelski D; Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
  • Belzberg AJ; Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
  • Hicks CW; Division of Vascular Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
  • Abularrage CJ; Division of Vascular Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
  • Lum YW; Division of Vascular Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: ylum1@jhmi.edu.
J Vasc Surg ; 77(2): 606-615, 2023 Feb.
Article em En | MEDLINE | ID: mdl-36273663
ABSTRACT

OBJECTIVE:

Neurogenic thoracic outlet syndrome (NTOS) is the most common form of thoracic outlet syndrome. However, NTOS has remained difficult to diagnose and treat successfully. The purpose of the present study was to generate a predictive clinical calculator for postoperative outcomes after first rib resection (FRR) for NTOS.

METHODS:

We performed a retrospective review of patients who had undergone FRR for NTOS at a single tertiary care institution between 2016 and 2020. A multivariate stepwise logistic regression analysis was performed to assess the association of the percentage of improvement after FRR with the patient baseline characteristics, pertinent clinical characteristics, and diagnostic criteria set by the Society for Vascular Surgery. The primary outcome was subjective patient improvement after FRR. A prediction risk calculator was developed using backward stepwise multivariate logistic regression coefficients. Bootstrapping was used for internal validation.

RESULTS:

A total of 208 patients (22.2% male; mean age, 35.8 ± 12.8 years; median follow-up, 44.9 months) had undergone 243 FRRs. Of the 208 patients, 94.7% had had symptoms localized to the supraclavicular area, and 97.6% had had symptoms in the hand. All the patients had had positive symptoms reproduced by the elevated arm stress test and upper limb tension test. Another reasonably likely diagnosis was absent for all the patients. Of the 196 patients who had received a lidocaine injection, 180 (93.3%) had experienced improvement of NTOS symptoms. Of the 95 patients who had received a Botox injection, 82 (74.6%) had experienced improvement of NTOS symptoms. Receiver operating characteristic curve analysis was used to assess the model. The area under the curve for the backward stepwise multivariate logistic regression model was 0.8. The multivariate logistic regression analyses revealed that the significant predictors of worsened clinical outcomes included hand weakness (adjusted odds ratio [aOR], 4.28; 95% confidence interval [CI], 1.04-17.74), increasing age (aOR, 0.93; 95% CI, 0.88-0.99), workers' compensation or litigation case (aOR, 0.09; 95% CI, 0.01-0.82), and symptoms in the dominant hand (aOR, 0.20; 95% CI, 0.05-0.88).

CONCLUSIONS:

Using retrospective data from a single-institution database, we have developed a prediction calculator with moderate to high predictive ability, as demonstrated by an area under the curve of 0.8. The tool (available at https//jhhntosriskcalculator.shinyapps.io/NTOS_calc/) is an important adjunct to clinical decision-making that can offer patients and providers realistic and personalized expectations of the postoperative outcome after FRR for NTOS. The findings from the present study have reinforced the diagnostic criteria set by the Society for Vascular Surgery. The calculator could aid physicians in surgical planning, referrals, and counseling patients on whether to proceed with surgery.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Síndrome do Desfiladeiro Torácico / Descompressão Cirúrgica Tipo de estudo: Diagnostic_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Assunto da revista: ANGIOLOGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Moldávia

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Síndrome do Desfiladeiro Torácico / Descompressão Cirúrgica Tipo de estudo: Diagnostic_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Assunto da revista: ANGIOLOGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Moldávia