TY - JOUR
T1 - Feasibility and Outcomes of a Multidisciplinary Care Pathway for Neurogenic Thoracic Outlet Syndrome
T2 - A Prospective Observational Cohort Study
AU - Pesser, Niels
AU - Goeteyn, Jens
AU - van der Sanden, Lieke
AU - Houterman, Saskia
AU - van Alfen, Nens
AU - van Sambeek, Marc R. H. M.
AU - van Nuenen, Bart F. L.
AU - Teijink, Joep A. W.
N1 - Funding Information:
The authors thank Mandy Swinkels (nurse practitioner) and Marieke Smelt (physician assistant) for the daily coordination of the thoracic outlet syndrome (TOS) care pathway and their contribution to data collection. The authors also thank the following members of the multidisciplinary team for their contributions to the diagnosis and treatment of the patients with neurogenic thoracic outlet syndrome: Niek Schepel (orthopaedic surgeon); Rob Gons (neurologist); Joris Hendriks, Lonneke Yo, and Menno Krietemeijer (radiologists); Marieke Sleegers, Bernice van der Pompe, and Wouter Oomen (TOS physiotherapists); and Hans van Suijlekom, Antal van der Gaag, Dries Oubaha, Walter ter Woerds, and Jurgen Koster (anaesthetists/pain specialists). The authors thank Lisanne Passier, Sanne Plat, and Yvonne Maassen (vascular laboratory technicians for the standardised elevated arm stress test [EAST]) for implementing the standardised EAST in daily care practice and all measurements. The authors thank Kimberly Vervaart (clinical neurophysiologist technician) for performing the nerve conduction studies and high resolution ultrasounds of the brachial plexus; Stijn Teijink (medical student) for the contribution to the data collection; and Dyanne Verhoeven (secretary TOS expert centre) for the contribution to the logistics of the questionnaires, follow up, and data collection for all the patients with NTOS.
Publisher Copyright:
© 2021 European Society for Vascular Surgery
PY - 2021/6
Y1 - 2021/6
N2 - Objective: The North American Society for Vascular Surgery (SVS) reporting standards for neurogenic thoracic outlet syndrome (NTOS) were published in 2016 to produce consistency in the diagnosis and treatment of NTOS, but outcomes resulting from following these standards are not yet available. The results of a standardised multidisciplinary care pathway for NTOS based on the North American SVS reporting standards for NTOS are reported.Methods: Patients referred between August 2016 and December 2019 with suspected NTOS were evaluated in this single center prospective cohort study. Diagnosis and treatment were performed according to a care pathway based on the North American SVS reporting standards. The outcome of surgically treated patients was determined by the Derkash score, thoracic outlet syndrome disability scale (TDS), Cervical Brachial Score Questionnaire (CBSQ), Disability of the Arm Shoulder and Hands Dutch language version (DASH-DLV) and Short Form-12 (SF-12) at three, six, 12, and 24 months.Results: Of 856 referred patients, 476 (55.6%) patients were diagnosed with NTOS. Dedicated physiotherapy was successful in 186 patients (39.1%). Surgical treatment was performed in 290 (60.9%) patients of whom 274 were included in the follow up. At a mean follow up of 16.9 +/- 9.2 months, significant improvement (p < .001) in TDS, CBSQ, DASH-DLV, and SF-12 scores was seen in the surgical group between baseline and all follow up intervals. Derkash outcome after surgical intervention was excellent in 83 (30.3%), good in 114 (41.6%), fair in 43 (15.7%), and poor in 34 (12.4%) of the patients. Complications occurred in 16 (5.8%) patients, and 32 (10.4%) patients experienced recurrent or persistent NTOS complaints.Conclusion: A multidisciplinary care pathway based on the North American SVS reporting standards for NTOS helped to confirm the diagnosis in 56% of patients referred, and guided the selection of patients who might benefit from thoracic outlet decompression surgery after unsuccessful dedicated physiotherapy. Intermediate follow up showed good outcomes in the majority of surgically treated patients.
AB - Objective: The North American Society for Vascular Surgery (SVS) reporting standards for neurogenic thoracic outlet syndrome (NTOS) were published in 2016 to produce consistency in the diagnosis and treatment of NTOS, but outcomes resulting from following these standards are not yet available. The results of a standardised multidisciplinary care pathway for NTOS based on the North American SVS reporting standards for NTOS are reported.Methods: Patients referred between August 2016 and December 2019 with suspected NTOS were evaluated in this single center prospective cohort study. Diagnosis and treatment were performed according to a care pathway based on the North American SVS reporting standards. The outcome of surgically treated patients was determined by the Derkash score, thoracic outlet syndrome disability scale (TDS), Cervical Brachial Score Questionnaire (CBSQ), Disability of the Arm Shoulder and Hands Dutch language version (DASH-DLV) and Short Form-12 (SF-12) at three, six, 12, and 24 months.Results: Of 856 referred patients, 476 (55.6%) patients were diagnosed with NTOS. Dedicated physiotherapy was successful in 186 patients (39.1%). Surgical treatment was performed in 290 (60.9%) patients of whom 274 were included in the follow up. At a mean follow up of 16.9 +/- 9.2 months, significant improvement (p < .001) in TDS, CBSQ, DASH-DLV, and SF-12 scores was seen in the surgical group between baseline and all follow up intervals. Derkash outcome after surgical intervention was excellent in 83 (30.3%), good in 114 (41.6%), fair in 43 (15.7%), and poor in 34 (12.4%) of the patients. Complications occurred in 16 (5.8%) patients, and 32 (10.4%) patients experienced recurrent or persistent NTOS complaints.Conclusion: A multidisciplinary care pathway based on the North American SVS reporting standards for NTOS helped to confirm the diagnosis in 56% of patients referred, and guided the selection of patients who might benefit from thoracic outlet decompression surgery after unsuccessful dedicated physiotherapy. Intermediate follow up showed good outcomes in the majority of surgically treated patients.
KW - Brachial plexus
KW - Physiotherapy
KW - Reporting standards
KW - Surgical treatment
KW - Thoracic outlet decompression
KW - Thoracic outlet syndrome
KW - TOS
KW - SURGERY
KW - DECOMPRESSION
KW - SUCCESS
U2 - 10.1016/j.ejvs.2021.02.048
DO - 10.1016/j.ejvs.2021.02.048
M3 - Article
C2 - 33810976
SN - 1078-5884
VL - 61
SP - 1017
EP - 1024
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 6
ER -