Specialty Mediated 30-Day Complications in First Rib Resection for Thoracic Outlet Syndrome

被引:1
|
作者
Sorber, Rebecca [1 ]
Weaver, M. Libby [2 ]
Canner, Joseph K. [3 ]
Campbell, Brady [3 ]
Black, James H., III [4 ]
Hicks, Caitlin W. [5 ]
Lum, Ying Wei [5 ]
机构
[1] Johns Hopkins Univ, Sch Med, Dept Surg, Halsted 668,600 N Wolfe St, Baltimore, MD 21287 USA
[2] Univ Florida, Dept Surg, Div Vasc Surg, Gainesville, FL USA
[3] Johns Hopkins Univ, Sch Med, Dept Surg, Ctr Outcomes Res, Baltimore, MD 21205 USA
[4] Johns Hopkins Univ, Sch Med, Dept Surg, Baltimore, MD 21205 USA
[5] Johns Hopkins Univ, Johns Hopkins Hosp, Bloomberg Sch Publ Hlth, Dept Surg, Baltimore, MD USA
关键词
Thoracic outlet syndrome; Neurogenic thoracic outlet syndrome; Venous thoracic outlet syndrome; Pagett Schroetter disease; First rib resection; Specialty mediated outcomes; PERIOPERATIVE OUTCOMES; SURGEON SPECIALTY; IMPACT;
D O I
10.1016/j.jss.2021.06.058
中图分类号
R61 [外科手术学];
学科分类号
摘要
A B S T R A C T Background: Thoracic outlet syndrome (TOS) takes on heterogenous upper extremity manifestations depending on whether the artery, vein or brachial plexus is primarily compressed. As a result of these variable vascular and neurogenic symptoms, these patients present to surgeons of various training backgrounds for surgical decompression. Surgeon specialty is known to correlate with outcomes for numerous vascular procedures, but its role in TOS is unclear. In this work we examine the association of surgeon specialty with short-term outcomes following first rib resection (FRRS) for TOS. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program database, 3,070 patients were identified who underwent FRRS for TOS between 2006-2017. The primary outcomes of the study were 30-d complications, including postoperative hemorrhage requiring transfusion, wound complications, pneumothorax and deep venous thrombosis. Arterial, venous, and neurogenic TOS were distinguished with ICD-9 and 10 codes while patient characteristics, provider specialty, and postoperative outcomes were classified through a combination of standard National Surgical Quality Improvement Program variables and ICD data. Results: Most FRRS were performed by vascular surgeons (87.9%), general (6.9%) and thoracic surgeons (4.4%). The relative distribution of vascular TOS between the specialties was not significantly different, with non-vascular surgeons performing an equivalent amount of FRRS for arterial (1.1% versus 2.4%) and venous TOS (8.6% versus 9.1%, both P > 0.05). Patients who underwent FRRS with non-vascular surgeons experienced more frequent perioperative transfusions (3.2% versus 1.2%, P = 0.001) and wound infections (1.9% versus 0.8%, P = 0.04). On multivariable regression, patients undergoing FRRS for venous TOS were more likely to require blood transfusion (odds ratios:3.63, 95% CI 1.43-9.25). Patients operated on by sur
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收藏
页码:214 / 220
页数:7
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