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

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/m), overweight (25.0-30.0 kg/m), and obesity (>30.0 kg/m). 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.