Just like when you go on a car journey you know there are risks but you set off to work knowing these; surgery is the same. We must know the risks, do all we can to avoid them but not worry about them.

The first is infection, this is rare but probably the most common risk; It is a bit like having a car tyre go flat, it happens but can be fixed relatively easily . We do all we can to avoid it (check the type pressures regularly and have our cars checked over yearly) but sometimes it happens.

Most of the time it is just more air is needed in the tyre and sometimes it is the tyre has to be changed but it does not stop us getting to work. infection is like this we do all we can to avoid it (the whole of surgery is really about avoiding infection) but in around 1 or 2 operations in every 100 or so an infection happens. Most of the time it is easily fixed (with antibiotics tablets) but sometimes it needs a ‘tyre change’ (the wound opening again and washing out).

The next risks are more serious but very rare. A bit like having a car crash. You know someone who has had one you do all you can do to avoid it but it should never happen. These are risks like a lot of bleeding during the operation (haemorrhage) or a blood clot happening after the operation which can go to your lungs (DVT or PE) the tissue fluid can sometimes leak (lymph leak) or the nerves can be damaged causing more pain or weakness. These can be a problem but properly managed will also be fine. They are very are and happen much less than 1 in every 100 cases.

Then there are things like a meteor hitting your car- you have seen it in films you know it could happen but really it never will. These are risks of any surgery going really wrong and involve what we call ‘never events’ things that should never happen but do sometimes. For example your symptoms being much much worse after surgery or a heart attack during the anaesthetic etc.

None of these risks to you in your car worry you, we are used to them and don’t think of them as risks. We go every day in the car (which you keep well serviced and checked) without a thought of them just knowing they are there. Risks in surgery are the same. All should be done to avoid them but they should not stop you going ahead with a procedure that can help.

I suppose there is one other risk in some surgery on nerves, and particularly in TOS surgery and that is that the surgery doesn’t improve your symptoms. That after surgery you are no better or just so little better that it is not noticeable. This happens to between 10-20 percent of people for TOS surgery. That afterwards the problem is not better – it probably means the symptoms were not caused by an issue at the thoracic outlet. In some patients the problems get better after surgery but over months after surgery scarring that happens after the surgery can lead those problems to come back (this is probably another 5-10 precent of patients).


Average improvement in symptoms

failure to improve