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To the Editor:
We commend Franklin et al.1 for trying to define the outcome of thoracic outlet syndrome (TOS) treatment in patients on workers’ compensation. They reviewed one group of patients who underwent surgery and a second group who did not. Franklin et al.1 correctly point out that “the two groups are not completely comparable so that strong conclusions are not warranted.” In fact, this statement is not strong enough, because the two groups are not at all comparable and no conclusions should be drawn. Unfortunately, a comparison of the groups is exactly what the authors have made, and therefore the study is flawed and the comparison invalid.
The selection criteria for surgery are not included, but it is reasonable to assume that surgery was offered to patients who had not responded to conservative therapy, and who were significantly disabled. The patients who did not undergo surgery were presumably those who had responded to conservative therapy and were not significantly disabled. This assumption is supported by the fact that the number of disability days in the 6 months prior to diagnosis was significantly higher in surgical versus nonsurgical patients (95 versus 65 days).
The article tries to give a picture of the outcome of the surgery, which was a transaxillary first rib resection with or without scalenectomy, in over 90% of the patients. The complication rate was quoted as 31.7%; a list of the complications was included in the article. …
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