Trends in the Management of Venous Thoracic Outlet Syndrome: A Nationwide Readmissions Database Study (2015-2021)

Introduction: Venous thoracic outlet syndrome (vTOS) is characterized by compression of the subclavian vein, which often results in deep vein thrombosis. Treatment typically involves thrombolysis followed by first rib resection to decompress the thoracic outlet. Given the relative rarity of vTOS, this study aims to examine contemporary trends in the treatment of vTOS, focusing on thrombolysis and rib resection outcomes from 2015 to 2021.

Methods: Data from the Nationwide Readmissions Database (NRD) between 2015 and 2021 were analyzed. Patients diagnosed with subclavian vTOS who underwent rib resection were included. The patients were divided based on the timing between thrombolysis and surgery: those receiving both treatments during the same hospitalization were classified as "simultaneous," and those receiving surgery at a later time were classified as "staged." Analysis included demographic data and outcome measures such as postoperative complications and readmissions.

Results: A total of 725 patients met the inclusion criteria, with a mean age of 33.7 ± 12.9 years, and 45.1% (327 of 725) were female. Among patients who underwent both thrombolysis and rib resection, 47.5% (223 of 470) had surgery within 14 days, 20.2% (95 of 470) between 14-30 days, and 32.3% (152 of 470) more than 30 days after thrombolysis. There was no significant difference in postoperative bleeding complications based on the time interval between thrombolysis and surgery. In terms of hospital visits, 21.4% (155 of 725) underwent "simultaneous" thrombolysis and surgery, while 42.1% (305 of 725) followed a "staged" approach. Additionally, 36.5% (265 of 725) underwent surgical decompression without prior thrombolysis.

Conclusion : Performing thrombolysis and first rib resection during the same hospital admission for vTOS does not increase the risk of bleeding complications compared to a staged approach. These findings suggest that simultaneous management is a safe and effective option for treating vTOS. Further research should explore the long-term outcomes and cost-effectiveness of different treatment strategies.