Abstract
BackgroundThe aim of this study was to explore the factors associated with the occurrence of ISP after VATS to reduce the incidence of ISP and improve patients' quality of life.MethodsThe data of patients were collected between June 2020 and August 2020 in the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital. The angle of upper arm was measured intraoperatively. The patient's postoperative shoulder function was quantified using the Constant-Murley shoulder function rating score. The proportional hazards model was applied to identify multiple influence factors.ResultsA total of 140 eligible patients met criteria. At postoperative day 3, only the age influenced patients' shoulder pain. At postoperative day 14, univariate and multivariate logistic regression analyses showed that age (odds ratio [OR]: 1.098 [1.046-1.152]; P < 0.001) and upper arm Angle A (OR: 1.064 [1.011-1.121]; P = 0.018) were independent risk factors for low shoulder function scores. However, height was its protective factor (OR: 0.923 [0.871-0.977]; P = 0.006). At postoperative day 42, univariate and multivariate logistic regression analyses showed that age (OR: 1.079 [1.036-1.124]; P < 0.001) was a risk factor for low shoulder function scores, and height (OR: 0.933 [0.886-0.983]; P = 0.009) was its protective factor. In contrast, upper arm Angle B was not statistically associated with low shoulder function scores (P>0.05). In addition, the reduction in ipsilateral Shoulder scores after surgery was higher in patients with more than 113° of angle A (P = 0.025).ConclusionISP was closely related to the angle of anterior flexion of the upper arm on the patient's operative side intraoperatively. The increase in the degree of postoperative shoulder injury is more pronounced for an anterior flexion angle of >113°. Therefore, we recommend that the angle of anterior flexion of the upper extremity should be <113° intraoperatively.
Highlights
Single-operator port thoracoscopic surgery is technically well established and accounts for more than 80% of thoracic surgical procedures
The two variables with significance in the univariate logistic regression were included in a multivariate logistic regression model, and the results showed that age was an independent risk factor for low shoulder function scores at 2 weeks postoperatively (OR: 0.94 [0.895–0.984]) and height was an independent protective factor for low shoulder function scores at 6 weeks postoperatively (OR: 0.933 [0.886–0.983], P = 0.009), both with statistically significant P-values
A longitudinal observational prospective cohort study found a significant correlation between postoperative muscle dysfunction of shoulder skeletal muscle and video-assisted thoracoscopic surgery (VATS), and this dysfunction still existed at 1 month postoperatively [5]
Summary
Single-operator port thoracoscopic surgery is technically well established and accounts for more than 80% of thoracic surgical procedures. Thoracic surgeons are more dedicated to explore the rapid recovery of single-operator port thoracoscopic surgery to maximize the advantages of minimally invasive surgery. A proportion of patients experience postoperative shoulder pain after single-operator port thoracoscopic surgery, known as ipsilateral shoulder pain (ISP), which was first defined by Mark and Brodsky [1, 2]. Shoulder pain occurring during this time is triggered by intraoperative manipulation that damages the nerves and muscles; the symptoms disappear quickly. Single-operating port thoracoscopic surgery is relatively less damaging to the nerves and muscles, and it triggers ISP largely because of periapical muscle ligament injury, which has a long recovery time and can last until 1 month after surgery [6]. The aim of this study was to explore the factors associated with the occurrence of ISP after VATS to reduce the incidence of ISP and improve patients’ quality of life
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