Compensatory Hyperhidrosis Following Endoscopic Thoracic Sympathectomy: A 5-Year Follow-Up Study of Risk Factors and Symptom Progression

Compensatory Hyperhidrosis Following Endoscopic Thoracic Sympathectomy: A 5-Year Follow-Up Study of Risk Factors and Symptom Progression | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Compensatory Hyperhidrosis Following Endoscopic Thoracic Sympathectomy: A 5-Year Follow-Up Study of Risk Factors and Symptom Progression Jian-Yang Wu, Jun-Kai Xiong, Cheng-Bin Huang, Shao-Hang Wu, Yang-Sheng Ou, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5894496/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Dec, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 11 You are reading this latest preprint version Abstract Background Compensatory hyperhidrosis (CH) is a common complication after endoscopic thoracic sympathectomy (ETS) for hyperhidrosis. Despite its prevalence, long-term data on CH progression and associated risk factors are scarce. This study evaluates the risk factors and progression of CH during a 5-year follow-up period. Methods This study retrospectively analyzed 138 patients with primary palmar hyperhidrosis (PPH) who underwent endoscopic thoracic sympathectomy between January 2014 and December 2019. All patients underwent bilateral single-port thoracoscopic sympathectomy and were followed up at 1, 3, and 5 years postoperatively. The severity of postoperative sweating was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with the development and progression of CH. Results A total of 138 patients were included in the study, with 78.9% reporting the occurrence of CH after surgery and 23.8% of them experiencing severe CH. HDSS scores increased over the 5 years postoperatively, with symptoms worsening. Further analysis revealed that bilateral R4-level sympathectomy significantly increased the risk of CH progression (OR = 4.28, 95% CI: 1.27–15.60, P = 0.021) while having three or more affected areas was identified as a protective factor (OR = 0.19, 95% CI: 0.05–0.63, P = 0.008). Conclusion This study found that compensatory hyperhidrosis is relatively common in patients undergoing ETS, and symptoms may progressively worsen over time. The level of sympathetic nerve resection and the number of affected areas are key predictive factors for worsening symptoms. compensatory hyperhidrosis endoscopic thoracic sympathectomy primary palmar hyperhidrosis HDSS score Figures Figure 1 Figure 2 Figure 3 Background Endoscopic thoracic sympathectomy (ETS) is a widely used surgical approach for treating primary hyperhidrosis, primarily aiming to reduce localized hyperhidrosis through sympathetic nerve interruption [ 1 , 2 ]. However, despite its effectiveness in alleviating primary hyperhidrosis symptoms, the occurrence of compensatory hyperhidrosis (CH) postoperatively has emerged as a significant clinical concern [ 3 – 5 ] CH is characterized by abnormal hyperhidrosis in other body areas after surgery, often leading to a decline in quality of life and potentially negatively impacting mental health [ 6 , 7 ]. Existing studies indicate a relatively high incidence of CH among ETS patients, with manifestations and severity varying among individuals [ 6 – 8 ]. The pathophysiology of CH remains not fully understood, but research suggests that the extent of sympathetic nerve interruption may closely relate to its occurrence and progression. Furthermore, some patients may experience increased hyperhidrosis in specific areas due to compensatory mechanisms following nerve interruption, influenced by factors such as the level of sympathetic nerve cutting, surgical techniques, and individual patient characteristics [ 9 ]. Notably, studies have also found that CH symptoms may gradually worsen over time postoperatively, impacting not only patients' physical comfort but also exacerbating psychological burdens, increasing the risk of anxiety and depression [ 10 ]. Therefore, understanding the long-term manifestations of CH and its associated risk factors is crucial. This study aims to systematically analyze patients who underwent ETS to assess the incidence of CH and its associated risk factors. We will focus on the relationship between the level of sympathetic nerve interruption and the occurrence of CH and potential protective factors influencing its severity. Through a comprehensive analysis of patient demographic characteristics and postoperative follow-up data, we aim to elucidate the risk factors for CH after ETS, aiding clinicians in better predicting and managing postoperative complications. Methods Study Population A retrospective analysis was conducted on 154 patients with primary palmar hyperhidrosis (PPH) who underwent endoscopic thoracic sympathectomy at the Department of Thoracic Surgery, Putian First Hospital, from January 2014 to December 2019. The surgical indication for endoscopic thoracic sympathectomy in our center was a diagnosis of PPH with a Hyperhidrosis Disease Severity Scale (HDSS) score of 3 or 4. The HDSS is a four-point self-reported questionnaire widely used to evaluate the severity of hyperhidrosis and its impact on daily life [ 11 , 12 ]. Exclusion criteria included: (1) secondary hyperhidrosis due to pulmonary tuberculosis, hyperthyroidism, or hypothalamic disorders; (2) bradycardia (heart rate < 55 bpm). We also excluded patients with a history of thoracic surgery or severe pulmonary infections, including tuberculosis, and those who underwent unilateral thoracoscopic sympathectomy. After contacting participants by phone for questionnaires and excluding those with missing data or dropouts, a total of 138 patients were included in the study. Approval was obtained from the Ethics Committee of Putian First Hospital, which waived the informed consent requirement for the use of patient medical records. All methods were conducted in accordance with the Declaration of Helsinki. Surgical Procedure All patients underwent bilateral single-port video-assisted thoracoscopic (VATS) sympathectomy with single-lung ventilation and double-lumen intubation. Patients were positioned supine with the upper body tilted at 45° and arms extended at 90° for stabilization. A 1 cm incision was made along the anterior axillary line at the third intercostal space. A 3 mm cannula and thoracoscope were inserted, and a pneumothorax was created using CO2 at 8 mmHg. After exploring the thoracic cavity and identifying the sympathetic nerve, the target sympathetic trunk was transected using an electrocautery hook. To ensure comprehensive removal of potential sympathetic nerve branches, the cauterization area was extended approximately 2 cm horizontally along the rib surface adjacent to the target nerve. Heart rate, blood pressure, oxygen saturation, palm temperature, and hyperhidrosis changes were monitored throughout the procedure. An increase in palm temperature of 1–2°C and a transition from wet to dry palms indicated the effectiveness of the procedure. Once confirmed that there were no leaks or bleeding, a drain was placed in the thoracic cavity, with its tip submerged in water to release gas. After lung re-expansion and confirmation of no residual air (no bubbles), the drain was removed, and the incision was sutured. Follow-up and Data Collection All patients underwent questionnaire surveys and telephone follow-ups using the Hyperhidrosis Severity Scale (HDSS scale, see Supplementary material) to assess the severity of hyperhidrosis after ETS. Data collected included demographic characteristics, preoperative treatments, recurrence rates, onset time and severity of palmar hyperhidrosis, CH location and severity, and CH changes at 1, 3, and 5 years postoperatively. We reviewed participants' electronic medical records to obtain more accurate information regarding quality of life and complications (e.g., recurrence or compensatory hyperhidrosis). In cases of discrepancies between online responses and medical records, we prioritized the information from medical records to minimize potential bias. Statistical Analysis After testing for normality using the Shapiro-Wilk test, all continuous variables were analyzed. Continuous variables were expressed as medians with interquartile ranges or means ± standard deviations. Categorical variables were presented as counts or percentages of patients in each group. Mann-Whitney tests or two-sample t-tests were used for analyzing continuous variables, while chi-square tests or Fisher's exact tests were employed for categorical variables. To analyze the temporal changes in CH, the Friedman test was used to compare the proportions of patients with different HDSS scores across three time points (1, 3, and 5 years). Post-hoc analyses were conducted using the Bonferroni method. Logistic regression was performed to identify risk factors associated with CH. The number of compensatory hyperhidrosis sites was treated as a continuous variable and later converted to a categorical variable with a cut-off of three after analyzing its correlation with compensatory hyperhidrosis and the receiver operating characteristic curve. Statistical analyses were conducted using R software version 4.3.0, with p-values less than 0.05 defined as statistically significant. Results Demographic Characteristics and Surgical Outcomes 138 patients were included in this study, with 52.9% being male. The mean age was 20 years [interquartile range (IQR): 17.0–25.0]. 22.5% of patients (n = 31) had received previous treatments, with the most common being topical herbal therapy (Table 1). No cases of Horner's syndrome or major adverse events were reported during the surgery. Compensatory Hyperhidrosis Postoperatively, 109 patients (78.9%) developed compensatory hyperhidrosis (CH), with 26 patients (23.8%) exhibiting severe CH, defined as an HDSS score of 3 or higher. There were no statistically significant differences between patients with and without CH regarding age, sex, BMI, smoking history, onset of hyperhidrosis, treatment history, family history, level of sympathetic nerve transection, or duration of surgery (Table 1). Univariate regression analysis did not identify any risk factors associated with the occurrence of CH (Table 2). Progression of CH and Risk Factors To further explore the progression of CH, we excluded patients who did not develop CH and those with an HDSS score of 3 or 4 in the first year postoperatively. A total of 83 patients were included in the analysis, with HDSS scores <3 defined as mild CH. The mean HDSS score was 1.69 (±0.516) at 1 year, 1.77 (±0.631) at 3 years, and 2.00 (±0.733) at 5 years. Compared to the first year, the HDSS score at 3 years showed no significant difference (p = 0.125), but the HDSS score at 5 years was significantly higher than the 1-year score (p = 0.001) (Table 3, Figure 1). Based on the HDSS score at 5 years, patients were divided into two groups: the deterioration group (18 patients) with a score of 3 or 4, indicating symptom worsening, and the non-deterioration group (65 patients) with a score of 1 or 2, indicating no significant change in symptoms. Significant differences were observed between the deterioration and non-deterioration groups in terms of the level of sympathetic nerve resection, the onset time of compensatory hyperhidrosis, and the number of affected CH areas, but no significant differences were found in age, sex, BMI, smoking history, age of onset of hyperhidrosis, treatment history, family history, or surgery duration (Table 4). The number of affected CH areas was initially treated as a continuous variable, but after evaluating its relationship with CH and the receiver operating characteristic (ROC) curve, it was converted to a categorical variable with a cutoff value of 3 (Figure 2). Figure 3 illustrates the areas most affected by CH. Notably, the soles of the feet were the most severely affected, while the thighs and face were less impacted. Risk Factor Analysis Risk factors for the progression of compensatory hyperhidrosis were further evaluated using univariate and multivariate logistic regression analyses. Univariate logistic regression analysis showed that, at the level of sympathetic nerve transection, bilateral R4 level was a risk factor compared to bilateral R3 level (OR=3.83, 95% CI: 1.29-11.36, p=0.016); the odds ratio for the time to onset of compensatory hyperhidrosis was 1.00 (95% CI: 1.00-1.01, p=0.036); compared to fewer than three affected CH sites, three or more were identified as a protective factor (OR=0.19, 95% CI: 0.06-0.59, p=0.004). In multivariate logistic regression analysis, bilateral R4 level remained a risk factor compared to bilateral R3 level (OR=4.28, 95% CI: 1.27-15.60, p=0.021); however, the effect of the time to onset of compensatory hyperhidrosis was not significant (OR=1.00, 95% CI: 1.00-1.01, p=0.090); and three or more affected CH sites were identified as a protective factor compared to fewer than three (OR=0.19, 95% CI: 0.05-0.63, p=0.008). These results indicate that the level of sympathetic nerve transection and the number of affected CH sites are significant risk factors for the worsening of CH. Discussion This study analyzed 138 patients to assess the incidence of compensatory hyperhidrosis (CH) and its associated risk factors following sympathectomy (ETS). Results indicated that 78.9% of patients developed CH, with 23.8% exhibiting severe CH, highlighting the relatively high incidence of CH as a common complication of ETS. This finding aligns with previous studies, emphasizing the importance of recognizing CH as a notable postoperative issue [ 8 , 13 , 14 ]. In our investigation of CH occurrence, we did not find significant differences among traditional risk factors such as age, sex, BMI, smoking status, and family history. However, Vasconcelos-Castro et al. reported favorable outcomes in 23 patients aged under 19 years [ 15 ], suggesting that a younger age may contribute to symptom improvement and a reduced risk of CH. This finding is consistent with other studies indicating that older age increases the risk of CH [ 16 , 17 ], Prior research has also linked higher BMI with CH incidence [ 2 , 18 – 20 ], Moreover, a meta-analysis by Zhang et al. indicated a lower occurrence of CH with R4 sympathectomy compared to R3 [ 21 ], The absence of identified risk factors in our study may be attributed to the limited sample size and patient characteristics. Future studies should further investigate the potential impact of these variables on CH by expanding the sample size and extending the follow-up duration. We observed a gradual increase in HDSS scores over the five-year postoperative period, indicating worsening CH symptoms. This suggests that while the surgery may alleviate primary hyperhidrosis symptoms, some patients may experience exacerbation of CH postoperatively [ 10 , 14 ], Previous research found significant worsening of compensatory hyperhidrosis symptoms between one and three months after ETS, but differences between three months and one year were less pronounced [ 7 ], Therefore, clinicians should thoroughly inform patients about this risk during the ETS procedure and consider implementing appropriate monitoring and management strategies [ 22 ]. In analyzing CH progression, we found a significant correlation between the degree of sympathetic nerve transection and the worsening of CH at five years postoperatively. Multivariate regression analysis indicated that bilateral R4 level was a significant risk factor for long-term worsening of CH compared to bilateral R3 level. This suggests that the level of nerve transection plays a critical role in the mechanisms underlying the progression of compensatory hyperhidrosis. Additionally, the number of affected CH sites was identified as a protective factor, indicating a potential threshold effect; when more areas are affected, patients may experience fewer symptoms. Wolosker et al. investigated the number of hyperhidrosis sites preoperatively, suggesting that this does not impact surgical outcomes or CH incidence [ 23 ], yet no studies have specifically examined the influence of the number of affected areas on CH symptoms. Our findings highlight the complexity of CH symptoms and their relationship with surgical techniques, prompting clinicians to consider these factors comprehensively when assessing and managing patient risks during ETS. In summary, this study underscores the importance of monitoring and managing compensatory hyperhidrosis post-ETS. The degree of sympathetic nerve transection and the number of affected CH sites may be important indicators for predicting CH worsening. Therefore, clinicians should engage in thorough communication with patients preoperatively to ensure a clear understanding of potential postoperative complications and implement appropriate follow-up and interventions. This study has several limitations. First, the limited sample size of 138 patients may affect the generalizability and statistical power of the results, restricting inferences regarding CH incidence across different populations and clinical contexts. Additionally, the single-center design may introduce selection bias, necessitating cautious interpretation of the external applicability of the findings; future multicenter studies will help provide a more comprehensive reflection of broader populations. Despite a five-year follow-up, the long-term effects of CH and its evolution over time require further observation to provide a more thorough perspective. Moreover, the assessment of CH symptoms relied primarily on self-reporting, which may introduce subjective bias, potentially affecting the accuracy and consistency of the results. Conclusions This study assessed the occurrence of compensatory hyperhidrosis (CH) and its associated risk factors in 138 patients who underwent endoscopic thoracic sympathectomy (ETS). The results showed that 78.9% of patients developed CH postoperatively, with 23.8% experiencing severe CH. Further analysis indicated that the extent of sympathetic nerve resection, particularly at the bilateral R4 level, was significantly associated with the progression of CH. At the same time, the number of affected areas was identified as a protective factor. These findings highlight the importance of monitoring and managing CH after ETS surgery. Abbreviations BMI Body mass index CH Compensatory hyperhidrosis ETS Endoscopic thoracic sympathectomy HDSS Hyperhidrosis Disease Severity Scale PPH Primary palmar hyperhidrosis VATS Video-assisted thoracoscopic surgery Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki, and the informed consent of every human participant was waived. The Internal Review Board of Putian First Hospital’s Ethics Committee reviewed and approved the present study. Data availability statement No datasets were generated or analysed during the current study. Author contributions SHW, ZZC, YSO and CBH collected the data; JXX and ZYX performed the ETS procedure; JYW and JKX analyzed these data; JYW wrote and revised this paper; JXX and ZYX participated in the study design and drafted the manuscript. All authors read and approved the final manuscript. Funding Not applicable. Consent for publication All the authors agree to the publication of this manuscript. Declaration of competing interest The authors report there are no competing interests to declare. Disclosure statement No potential conflict of interest was reported by the author(s). Acknowledgements Not applicable. References Hsu CP, Shia SE, Hsia JY, Chuang CY.Chen CY. Experiences in thoracoscopic sympathectomy for axillary hyperhidrosis and osmidrosis: focusing on the extent of sympathectomy. Arch Surg. 2001;136(10):1115-7. Xu J, Liang W, Cai J, Xiong J, Huang C, Xu Z.Guan J. Long term outcomes and risk factors of compensatory hyperhidrosis after thoracoscopic sympathectomy in primary palmar hyperhidrosis patients: a retrospective single-center study. J Cardiothorac Surg. 2024;19(1):590. Lin TS.Chou MC. Needlescopic thoracic sympathetic block by clipping for craniofacial hyperhidrosis: an analysis of 28 cases. Surg Endosc. 2002;16(7):1055-8. Lin TS, Kuo SJ.Chou MC. Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: analysis of 2000 cases. Neurosurgery. 2002;51(5 Suppl):S84-7. Fredman B, Zohar E, Shachor D, Bendahan J.Jedeikin R. Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: friend or foe? Surg Laparosc Endosc Percutan Tech. 2000;10(4):226-9. Horslen LC, Wilshire CL, Louie BE.Vallières E. Long-Term Impact of Endoscopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis. Ann Thorac Surg. 2018;106(4):1008-12. Woo W, Kim BJ, Kang DY, Won J, Moon DH.Lee S. Patient experience and prognostic factors of compensatory hyperhidrosis and recurrence after endoscopic thoracic sympathicotomy. Surg Endosc. 2022;36(11):8340-48. Turhan K, Kavurmaci Ö, Akçam T, Ergönül AG, Özdil A, Çakan A.Çağirici U. Long-Term Outcomes and Course of Compensatory Sweating after Endoscopic Sympathicotomy. Thorac Cardiovasc Surg. 2022;70(2):167-72. JL H, JR O.KB F. 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Tables Table 1 Patient characteristics and operative data of patients who underwent ETS Total (N=138) Non-CH group ( N = 29) CH group ( N = 109) P -value Age, years, Median (IQR) 20.50 (17.00-25.00) 20.00 (16.00-24.00) 21.00 (17.00-25.00) 0.299 Gender, No. (%) 0.441 Female 65 (47.10) 16 (55.17) 49 (44.95) Male 73 (52.90) 13 (44.83) 60 (55.05) BMI, kg/m2, Mean±SD 21.59 (2.97) 20.70 (2.64) 21.82 (3.02) 0.069 Smoking, No. (%) 0.443 No 111 (80.43) 25 (86.21) 86 (78.90) Yes 27 (19.57) 4 (13.79) 23 (21.10) Onset age a , year, Median (IQR) 8.00 (7.00-10.00) 8.00 (6.00-9.00) 8.00 (7.00-10.00) 0.737 Preoperative treatment, No. (%) 0.135 Without treatment 107 (77.54) 19 (65.52) 88 (80.73) With treatment 31 (22.46) 10 (34.48) 21 (19.27) Family history, No. (%) 0.985 No 93 (67.39) 19 (65.52) 74 (67.89) Yes 45 (32.61) 10 (34.48) 35 (32.11) Level of surgery, No. (%) 0.642 Bilateral R3 93 (67.39) 18 (62.07) 75 (68.81) Bilateral R4 45 (32.61) 11 (37.93) 34 (31.19) Operation time, min, Median (IQR) 39.50 (30.00-48.75) 39.00 (30.00-45.00) 40.00 (30.00-50.00) 0.831 Abbreviations: CH, compensatory hyperhidrosis; IQR, interquartile range; SD, standard deviation; BMI, body mass index; R3, third rib level; R4, fourth rib level; ETS, endoscopic thoracic sympathectomy. a Onset age refers to the time of occurrence of primary hand hyperhidrosis. Table 2 Univariate analysis for compensatory hyperhidrosis Variables Univariate analysis OR (95%CI) P-value Age 1.04 (0.97-1.12) 0.271 Gender 0.329 Female ref Male 1.51 (0.66-3.43) BMI 1.15 (0.99-1.33) 0.071 Smoking 0.382 No ref Yes 1.67 (0.53-5.29) Onset age 0.99 (0.88-1.12) 0.862 Preoperative treatment 0.086 Without treatment ref With treatment 0.45 (0.18-1.12) Family history 0.809 No ref Yes 0.90 (0.38-2.13) Level of surgery 0.492 Bilateral R3 ref Bilateral R4 0.74 (0.32-1.74) Operation time 1.01 (0.98-1.04) 0.494 Table 3 HDSS scores of compensatory hyperhidrosis across different postoperative periods HDSS score number of patients (%) Pairwise comparison 0 1 2 3 4 Mean ± SD P-value Postoperative Period, No. (%) 1 year 2 (2.4) 22 (26.5) 59 (71.1) 0 0 1.69 ±0.516 ref 3 years 2 (2.4) 21 (25.3) 55 (66.3) 4 (4.8) 1 (1.2) 1.77 ±0.631 0.125 5 years 0 20 (24.1) 45 (54.2) 16 (19.3) 2 (2.4) 2.00±0.733 0.001 Table 4 Baseline and surgical characteristics of patients with compensatory hyperhidrosis Non-Worsened group ( N = 65) Worsened group ( N = 18) P -value Age, years, Median (IQR) 21.00 (17.00-25.00) 19.00 (17.00-27.25) 0.799 Gender, No. (%) 1.000 Female 25 (38.46) 7 (38.89) Male 40 (61.54) 11 (61.11) BMI, kg/m2, Mean ± SD 21.91 (3.24) 20.79 (1.97) 0.170 Smoking, No. (%) 1.000 No 51 (78.46) 14 (77.78) Yes 14 (21.54) 4 (22.22) Onset age a , year, Median (IQR) 8.00 (7.00-10.00) 7.00 (6.00-8.00) 0.052 Preoperative treatment, No. (%) 0.326 Without treatment 54 (83.08) 14 (77.78) With treatment 11 (16.92) 4 (22.22) Family history, No. (%) 1.000 No 47 (72.31) 13 (72.22) Yes 18 (27.69) 5 (27.78) Level of surgery, No. (%) 0.027 Bilateral R3 49 (75.38) 8 (44.44) Bilateral R4 16 (24.62) 10 (55.56) Operation time, min, Median (IQR) 38.00 (30.00-50.00) 36.00 (25.00-54.50) 0.982 Duration b , day, median (IQR) 30.00 (14.00-60.00) 60.00 (30.00-360.00) 0.007 Number of affected areas c , Median (IQR) 4.00 (2.00-4.00) 2.00 (1.00-3.00) <0.001 Abbreviations: CH, compensatory hyperhidrosis; IQR, interquartile range; SD, standard deviation; BMI, body mass index; R3, third rib level; R4, fourth rib level; ETS, endoscopic thoracic sympathectomy. a Onset age refers to the time of occurrence of primary hand hyperhidrosis; b Duration refers to the period since the onset of compensatory sweating; c Number of affected areas refers to the sites involved in compensatory hyperhidrosis. Table 5 Univariate and multivariable analyses for the worsening of compensatory hyperhidrosis Variables Univariate analysis multivariable analysis OR (95%CI) P-value OR (95%CI) P-value Age 1.05 (0.98-1.12) 0.164 Gender 0.974 Female ref Male 0.98 (0.34-2.87) BMI 0.88 (0.73-1.06) 0.171 Smoking 0.950 No ref Yes 1.04 (0.30-3.66) Onset age 1.00 (0.85-1.16) 0.958 Preoperative treatment 0.606 Without treatment ref With treatment 1.40 (0.39-5.08) Family history 0.994 No ref Yes 1.00 (0.31-3.22) Level of surgery 0.016 0.021 Bilateral R3 ref ref Bilateral R4 3.83 (1.29-11.36) 4.28 (1.27-15.60) Operation time 1.01 (0.97-1.04) 0.817 Duration 1.00 (1.00-1.01） 0.036 1.00 (1.00-1.01) 0.090 Number of affected areas 0.004 0.008 =3 0.19 (0.06-0.59) 0.19 (0.05-0.63) Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial.docx Cite Share Download PDF Status: Published Journal Publication published 08 Dec, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 13 Sep, 2025 Reviews received at journal 22 Jun, 2025 Reviews received at journal 10 Jun, 2025 Reviewers agreed at journal 09 Jun, 2025 Reviews received at journal 06 Jun, 2025 Reviewers agreed at journal 06 Jun, 2025 Reviewers agreed at journal 02 Jun, 2025 Reviewers invited by journal 28 May, 2025 Editor assigned by journal 27 Jan, 2025 Submission checks completed at journal 27 Jan, 2025 First submitted to journal 24 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5894496","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":407687054,"identity":"82384281-771e-4dd8-817f-8e87ee055203","order_by":0,"name":"Jian-Yang Wu","email":"","orcid":"","institution":"Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian 351100, Fujian, China","correspondingAuthor":false,"prefix":"","firstName":"Jian-Yang","middleName":"","lastName":"Wu","suffix":""},{"id":407687055,"identity":"099e1be5-9658-40e6-a7c4-75224e9f62c4","order_by":1,"name":"Jun-Kai Xiong","email":"","orcid":"","institution":"Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian 351100, Fujian, China","correspondingAuthor":false,"prefix":"","firstName":"Jun-Kai","middleName":"","lastName":"Xiong","suffix":""},{"id":407687056,"identity":"197d67a3-ed7b-40a6-b793-c7909aba7afd","order_by":2,"name":"Cheng-Bin Huang","email":"","orcid":"","institution":"Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian 351100, Fujian, China","correspondingAuthor":false,"prefix":"","firstName":"Cheng-Bin","middleName":"","lastName":"Huang","suffix":""},{"id":407687057,"identity":"a41936bc-fb3d-4e95-b6d7-0cabf0d882f8","order_by":3,"name":"Shao-Hang Wu","email":"","orcid":"","institution":"Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian 351100, Fujian, China","correspondingAuthor":false,"prefix":"","firstName":"Shao-Hang","middleName":"","lastName":"Wu","suffix":""},{"id":407687058,"identity":"09c61f8d-8919-4b2f-94d8-132ab3528f1a","order_by":4,"name":"Yang-Sheng Ou","email":"","orcid":"","institution":"Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian 351100, Fujian, China","correspondingAuthor":false,"prefix":"","firstName":"Yang-Sheng","middleName":"","lastName":"Ou","suffix":""},{"id":407687059,"identity":"8a3cec3e-ac4e-40a2-a69f-87eabe9211fe","order_by":5,"name":"Zhi-Zhou Chen","email":"","orcid":"","institution":"Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian 351100, Fujian, China","correspondingAuthor":false,"prefix":"","firstName":"Zhi-Zhou","middleName":"","lastName":"Chen","suffix":""},{"id":407687060,"identity":"f454f7af-5650-41f6-ba53-06aa1ec1a37a","order_by":6,"name":"Zhi-Yang Xu","email":"","orcid":"","institution":"Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian 351100, Fujian, China","correspondingAuthor":false,"prefix":"","firstName":"Zhi-Yang","middleName":"","lastName":"Xu","suffix":""},{"id":407687061,"identity":"adedde9b-b649-489f-b803-9ad907ace666","order_by":7,"name":"Jian-Xin Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYHCChANAgoeBvfnAgYQKCTl+4rXwHEs88OGMhbFkA9GWSeQYH5zZVpG4gZAWgxsJDw/83HFYxpzngMFh3nkSjBsYmB8+uoFHi+SMhISDvWfSeCzbGxIO826TYDZnYDM2zsGjhV8iIeEAb5sNj8GZAwdAWtgsG3jYpPFpYQNqOfi3TYLH4EZiw2HeOUDGAQJaQLYcBttyI5nh4MwGCQmCWiR7HiQclm1LAzrsGMOBD8ckDCSbCfjF4HhO8se3bYftDY73f/6QUFNX38/e/PAxPi3ASExAE2DGqxwE2A8QVDIKRsEoGAUjHAAAGA1THqEgS/oAAAAASUVORK5CYII=","orcid":"","institution":"Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian 351100, Fujian, China","correspondingAuthor":true,"prefix":"","firstName":"Jian-Xin","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2025-01-24 09:53:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5894496/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5894496/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-025-03720-3","type":"published","date":"2025-12-08T15:58:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75312728,"identity":"f1d95ef8-4542-46f3-98cb-a03f90abd1f1","added_by":"auto","created_at":"2025-02-03 09:16:33","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28856,"visible":true,"origin":"","legend":"\u003cp\u003eThe mean HDSS scores were 1.69 at 1 year, 1.77 at 3 years, and 2.00 at 5 years postoperatively. No significant difference was found between the 1-year and 3-year scores (p = 0.125). However, the 5-year score was significantly higher than the 1-year score (p = 0.001)\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5894496/v1/475842d85957dbd69808a51a.jpg"},{"id":75312729,"identity":"9b55cf0a-4abc-4626-b615-593a72e79157","added_by":"auto","created_at":"2025-02-03 09:16:33","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23959,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic (ROC) curve analysis was conducted using the number of affected areas in compensatory hyperhidrosis as an independent variable and worsening of compensatory hyperhidrosis (CH) as the dependent variable. The area under the curve (AUC) was 0.765 (95% confidence interval: 0.648–0.883). The optimal cutoff value was determined to be 2.5\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5894496/v1/8a3031bd8ca960a40f1ebd35.jpg"},{"id":75313777,"identity":"eaa49f56-9be1-453d-b185-4c015c2c25d9","added_by":"auto","created_at":"2025-02-03 09:24:34","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29446,"visible":true,"origin":"","legend":"\u003cp\u003eRegional distribution of compensatory hyperhidrosis (CH, depicted by the number of affected areas)\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5894496/v1/4e73f3102bec85bb40ec398d.jpg"},{"id":98245091,"identity":"2d18d478-c372-42de-9076-bbc257322954","added_by":"auto","created_at":"2025-12-15 16:16:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":932077,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5894496/v1/d6376cea-aeac-42c2-aa04-efc9c139d773.pdf"},{"id":75312731,"identity":"19c87b91-2f7b-4aba-b2ab-1b89edf841d0","added_by":"auto","created_at":"2025-02-03 09:16:33","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13827,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-5894496/v1/7a8747ffac352704077032fc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Compensatory Hyperhidrosis Following Endoscopic Thoracic Sympathectomy: A 5-Year Follow-Up Study of Risk Factors and Symptom Progression","fulltext":[{"header":"Background","content":"\u003cp\u003eEndoscopic thoracic sympathectomy (ETS) is a widely used surgical approach for treating primary hyperhidrosis, primarily aiming to reduce localized hyperhidrosis through sympathetic nerve interruption [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, despite its effectiveness in alleviating primary hyperhidrosis symptoms, the occurrence of compensatory hyperhidrosis (CH) postoperatively has emerged as a significant clinical concern [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] CH is characterized by abnormal hyperhidrosis in other body areas after surgery, often leading to a decline in quality of life and potentially negatively impacting mental health [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExisting studies indicate a relatively high incidence of CH among ETS patients, with manifestations and severity varying among individuals [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The pathophysiology of CH remains not fully understood, but research suggests that the extent of sympathetic nerve interruption may closely relate to its occurrence and progression. Furthermore, some patients may experience increased hyperhidrosis in specific areas due to compensatory mechanisms following nerve interruption, influenced by factors such as the level of sympathetic nerve cutting, surgical techniques, and individual patient characteristics [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNotably, studies have also found that CH symptoms may gradually worsen over time postoperatively, impacting not only patients' physical comfort but also exacerbating psychological burdens, increasing the risk of anxiety and depression [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, understanding the long-term manifestations of CH and its associated risk factors is crucial.\u003c/p\u003e \u003cp\u003eThis study aims to systematically analyze patients who underwent ETS to assess the incidence of CH and its associated risk factors. We will focus on the relationship between the level of sympathetic nerve interruption and the occurrence of CH and potential protective factors influencing its severity. Through a comprehensive analysis of patient demographic characteristics and postoperative follow-up data, we aim to elucidate the risk factors for CH after ETS, aiding clinicians in better predicting and managing postoperative complications.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on 154 patients with primary palmar hyperhidrosis (PPH) who underwent endoscopic thoracic sympathectomy at the Department of Thoracic Surgery, Putian First Hospital, from January 2014 to December 2019. The surgical indication for endoscopic thoracic sympathectomy in our center was a diagnosis of PPH with a Hyperhidrosis Disease Severity Scale (HDSS) score of 3 or 4. The HDSS is a four-point self-reported questionnaire widely used to evaluate the severity of hyperhidrosis and its impact on daily life [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Exclusion criteria included: (1) secondary hyperhidrosis due to pulmonary tuberculosis, hyperthyroidism, or hypothalamic disorders; (2) bradycardia (heart rate\u0026thinsp;\u0026lt;\u0026thinsp;55 bpm). We also excluded patients with a history of thoracic surgery or severe pulmonary infections, including tuberculosis, and those who underwent unilateral thoracoscopic sympathectomy. After contacting participants by phone for questionnaires and excluding those with missing data or dropouts, a total of 138 patients were included in the study. Approval was obtained from the Ethics Committee of Putian First Hospital, which waived the informed consent requirement for the use of patient medical records. All methods were conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical Procedure\u003c/h3\u003e\n\u003cp\u003eAll patients underwent bilateral single-port video-assisted thoracoscopic (VATS) sympathectomy with single-lung ventilation and double-lumen intubation. Patients were positioned supine with the upper body tilted at 45\u0026deg; and arms extended at 90\u0026deg; for stabilization. A 1 cm incision was made along the anterior axillary line at the third intercostal space. A 3 mm cannula and thoracoscope were inserted, and a pneumothorax was created using CO2 at 8 mmHg. After exploring the thoracic cavity and identifying the sympathetic nerve, the target sympathetic trunk was transected using an electrocautery hook. To ensure comprehensive removal of potential sympathetic nerve branches, the cauterization area was extended approximately 2 cm horizontally along the rib surface adjacent to the target nerve. Heart rate, blood pressure, oxygen saturation, palm temperature, and hyperhidrosis changes were monitored throughout the procedure. An increase in palm temperature of 1\u0026ndash;2\u0026deg;C and a transition from wet to dry palms indicated the effectiveness of the procedure. Once confirmed that there were no leaks or bleeding, a drain was placed in the thoracic cavity, with its tip submerged in water to release gas. After lung re-expansion and confirmation of no residual air (no bubbles), the drain was removed, and the incision was sutured.\u003c/p\u003e\n\u003ch3\u003eFollow-up and Data Collection\u003c/h3\u003e\n\u003cp\u003eAll patients underwent questionnaire surveys and telephone follow-ups using the Hyperhidrosis Severity Scale (HDSS scale, see Supplementary material) to assess the severity of hyperhidrosis after ETS. Data collected included demographic characteristics, preoperative treatments, recurrence rates, onset time and severity of palmar hyperhidrosis, CH location and severity, and CH changes at 1, 3, and 5 years postoperatively. We reviewed participants' electronic medical records to obtain more accurate information regarding quality of life and complications (e.g., recurrence or compensatory hyperhidrosis). In cases of discrepancies between online responses and medical records, we prioritized the information from medical records to minimize potential bias.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAfter testing for normality using the Shapiro-Wilk test, all continuous variables were analyzed. Continuous variables were expressed as medians with interquartile ranges or means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations. Categorical variables were presented as counts or percentages of patients in each group. Mann-Whitney tests or two-sample t-tests were used for analyzing continuous variables, while chi-square tests or Fisher's exact tests were employed for categorical variables. To analyze the temporal changes in CH, the Friedman test was used to compare the proportions of patients with different HDSS scores across three time points (1, 3, and 5 years). Post-hoc analyses were conducted using the Bonferroni method. Logistic regression was performed to identify risk factors associated with CH. The number of compensatory hyperhidrosis sites was treated as a continuous variable and later converted to a categorical variable with a cut-off of three after analyzing its correlation with compensatory hyperhidrosis and the receiver operating characteristic curve. Statistical analyses were conducted using R software version 4.3.0, with p-values less than 0.05 defined as statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic Characteristics and Surgical Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e138 patients were included in this study, with 52.9% being male. The mean age was 20 years [interquartile range (IQR): 17.0–25.0]. 22.5% of patients (n = 31) had received previous treatments, with the most common being topical herbal therapy (Table 1). No cases of Horner's syndrome or major adverse events were reported during the surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompensatory Hyperhidrosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePostoperatively, 109 patients (78.9%) developed compensatory hyperhidrosis (CH), with 26 patients (23.8%) exhibiting severe CH, defined as an HDSS score of 3 or higher. There were no statistically significant differences between patients with and without CH regarding age, sex, BMI, smoking history, onset of hyperhidrosis, treatment history, family history, level of sympathetic nerve transection, or duration of surgery (Table 1). Univariate regression analysis did not identify any risk factors associated with the occurrence of CH (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProgression of CH and Risk Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo further explore the progression of CH, we excluded patients who did not develop CH and those with an HDSS score of 3 or 4 in the first year postoperatively. A total of 83 patients were included in the analysis, with HDSS scores \u0026lt;3 defined as mild CH. The mean HDSS score was 1.69 (±0.516) at 1 year, 1.77 (±0.631) at 3 years, and 2.00 (±0.733) at 5 years. Compared to the first year, the HDSS score at 3 years showed no significant difference (p = 0.125), but the HDSS score at 5 years was significantly higher than the 1-year score (p = 0.001) (Table 3, Figure 1).\u003c/p\u003e\n\u003cp\u003eBased on the HDSS score at 5 years, patients were divided into two groups: the deterioration group (18 patients) with a score of 3 or 4, indicating symptom worsening, and the non-deterioration group (65 patients) with a score of 1 or 2, indicating no significant change in symptoms. Significant differences were observed between the deterioration and non-deterioration groups in terms of the level of sympathetic nerve resection, the onset time of compensatory hyperhidrosis, and the number of affected CH areas, but no significant differences were found in age, sex, BMI, smoking history, age of onset of hyperhidrosis, treatment history, family history, or surgery duration (Table 4). The number of affected CH areas was initially treated as a continuous variable, but after evaluating its relationship with CH and the receiver operating characteristic (ROC) curve, it was converted to a categorical variable with a cutoff value of 3 (Figure 2).\u003c/p\u003e\n\u003cp\u003eFigure 3 illustrates the areas most affected by CH. Notably, the soles of the feet were the most severely affected, while the thighs and face were less impacted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk Factor Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRisk factors for the progression of compensatory hyperhidrosis were further evaluated using univariate and multivariate logistic regression analyses. Univariate logistic regression analysis showed that, at the level of sympathetic nerve transection, bilateral R4 level was a risk factor compared to bilateral R3 level (OR=3.83, 95% CI: 1.29-11.36, p=0.016); the odds ratio for the time to onset of compensatory hyperhidrosis was 1.00 (95% CI: 1.00-1.01, p=0.036); compared to fewer than three affected CH sites, three or more were identified as a protective factor (OR=0.19, 95% CI: 0.06-0.59, p=0.004).\u003c/p\u003e\n\u003cp\u003eIn multivariate logistic regression analysis, bilateral R4 level remained a risk factor compared to bilateral R3 level (OR=4.28, 95% CI: 1.27-15.60, p=0.021); however, the effect of the time to onset of compensatory hyperhidrosis was not significant (OR=1.00, 95% CI: 1.00-1.01, p=0.090); and three or more affected CH sites were identified as a protective factor compared to fewer than three (OR=0.19, 95% CI: 0.05-0.63, p=0.008). These results indicate that the level of sympathetic nerve transection and the number of affected CH sites are significant risk factors for the worsening of CH.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study analyzed 138 patients to assess the incidence of compensatory hyperhidrosis (CH) and its associated risk factors following sympathectomy (ETS). Results indicated that 78.9% of patients developed CH, with 23.8% exhibiting severe CH, highlighting the relatively high incidence of CH as a common complication of ETS. This finding aligns with previous studies, emphasizing the importance of recognizing CH as a notable postoperative issue [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our investigation of CH occurrence, we did not find significant differences among traditional risk factors such as age, sex, BMI, smoking status, and family history. However, Vasconcelos-Castro et al. reported favorable outcomes in 23 patients aged under 19 years [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], suggesting that a younger age may contribute to symptom improvement and a reduced risk of CH. This finding is consistent with other studies indicating that older age increases the risk of CH [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], Prior research has also linked higher BMI with CH incidence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], Moreover, a meta-analysis by Zhang et al. indicated a lower occurrence of CH with R4 sympathectomy compared to R3 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], The absence of identified risk factors in our study may be attributed to the limited sample size and patient characteristics. Future studies should further investigate the potential impact of these variables on CH by expanding the sample size and extending the follow-up duration.\u003c/p\u003e \u003cp\u003eWe observed a gradual increase in HDSS scores over the five-year postoperative period, indicating worsening CH symptoms. This suggests that while the surgery may alleviate primary hyperhidrosis symptoms, some patients may experience exacerbation of CH postoperatively [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], Previous research found significant worsening of compensatory hyperhidrosis symptoms between one and three months after ETS, but differences between three months and one year were less pronounced [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], Therefore, clinicians should thoroughly inform patients about this risk during the ETS procedure and consider implementing appropriate monitoring and management strategies [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn analyzing CH progression, we found a significant correlation between the degree of sympathetic nerve transection and the worsening of CH at five years postoperatively. Multivariate regression analysis indicated that bilateral R4 level was a significant risk factor for long-term worsening of CH compared to bilateral R3 level. This suggests that the level of nerve transection plays a critical role in the mechanisms underlying the progression of compensatory hyperhidrosis. Additionally, the number of affected CH sites was identified as a protective factor, indicating a potential threshold effect; when more areas are affected, patients may experience fewer symptoms. Wolosker et al. investigated the number of hyperhidrosis sites preoperatively, suggesting that this does not impact surgical outcomes or CH incidence [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], yet no studies have specifically examined the influence of the number of affected areas on CH symptoms. Our findings highlight the complexity of CH symptoms and their relationship with surgical techniques, prompting clinicians to consider these factors comprehensively when assessing and managing patient risks during ETS.\u003c/p\u003e \u003cp\u003eIn summary, this study underscores the importance of monitoring and managing compensatory hyperhidrosis post-ETS. The degree of sympathetic nerve transection and the number of affected CH sites may be important indicators for predicting CH worsening. Therefore, clinicians should engage in thorough communication with patients preoperatively to ensure a clear understanding of potential postoperative complications and implement appropriate follow-up and interventions.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the limited sample size of 138 patients may affect the generalizability and statistical power of the results, restricting inferences regarding CH incidence across different populations and clinical contexts. Additionally, the single-center design may introduce selection bias, necessitating cautious interpretation of the external applicability of the findings; future multicenter studies will help provide a more comprehensive reflection of broader populations. Despite a five-year follow-up, the long-term effects of CH and its evolution over time require further observation to provide a more thorough perspective. Moreover, the assessment of CH symptoms relied primarily on self-reporting, which may introduce subjective bias, potentially affecting the accuracy and consistency of the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study assessed the occurrence of compensatory hyperhidrosis (CH) and its associated risk factors in 138 patients who underwent endoscopic thoracic sympathectomy (ETS). The results showed that 78.9% of patients developed CH postoperatively, with 23.8% experiencing severe CH. Further analysis indicated that the extent of sympathetic nerve resection, particularly at the bilateral R4 level, was significantly associated with the progression of CH. At the same time, the number of affected areas was identified as a protective factor. These findings highlight the importance of monitoring and managing CH after ETS surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI Body mass index\u003c/p\u003e\n\u003cp\u003eCH Compensatory hyperhidrosis\u003c/p\u003e\n\u003cp\u003eETS Endoscopic thoracic sympathectomy\u003c/p\u003e\n\u003cp\u003eHDSS Hyperhidrosis Disease Severity Scale\u003c/p\u003e\n\u003cp\u003ePPH Primary palmar hyperhidrosis\u003c/p\u003e\n\u003cp\u003eVATS Video-assisted thoracoscopic surgery\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki, and the informed consent of every human participant was waived. The Internal Review Board of Putian First Hospital’s Ethics Committee reviewed and approved the present study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSHW, ZZC, YSO and CBH collected the data; JXX and ZYX performed the ETS procedure; JYW and JKX analyzed these data; JYW wrote and revised this paper; JXX and ZYX participated in the study design and drafted the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors agree to the publication of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report there are no competing interests to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflict of interest was reported by the author(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHsu CP, Shia SE, Hsia JY, Chuang CY.Chen CY. Experiences in thoracoscopic sympathectomy for axillary hyperhidrosis and osmidrosis: focusing on the extent of sympathectomy. Arch Surg. 2001;136(10):1115-7.\u003c/li\u003e\n\u003cli\u003eXu J, Liang W, Cai J, Xiong J, Huang C, Xu Z.Guan J. Long term outcomes and risk factors of compensatory hyperhidrosis after thoracoscopic sympathectomy in primary palmar hyperhidrosis patients: a retrospective single-center study. J Cardiothorac Surg. 2024;19(1):590.\u003c/li\u003e\n\u003cli\u003eLin TS.Chou MC. Needlescopic thoracic sympathetic block by clipping for craniofacial hyperhidrosis: an analysis of 28 cases. Surg Endosc. 2002;16(7):1055-8.\u003c/li\u003e\n\u003cli\u003eLin TS, Kuo SJ.Chou MC. Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: analysis of 2000 cases. Neurosurgery. 2002;51(5 Suppl):S84-7.\u003c/li\u003e\n\u003cli\u003eFredman B, Zohar E, Shachor D, Bendahan J.Jedeikin R. Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: friend or foe? Surg Laparosc Endosc Percutan Tech. 2000;10(4):226-9.\u003c/li\u003e\n\u003cli\u003eHorslen LC, Wilshire CL, Louie BE.Valli\u0026egrave;res E. Long-Term Impact of Endoscopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis. Ann Thorac Surg. 2018;106(4):1008-12.\u003c/li\u003e\n\u003cli\u003eWoo W, Kim BJ, Kang DY, Won J, Moon DH.Lee S. Patient experience and prognostic factors of compensatory hyperhidrosis and recurrence after endoscopic thoracic sympathicotomy. Surg Endosc. 2022;36(11):8340-48.\u003c/li\u003e\n\u003cli\u003eTurhan K, Kavurmaci \u0026Ouml;, Ak\u0026ccedil;am T, Erg\u0026ouml;n\u0026uuml;l AG, \u0026Ouml;zdil A, \u0026Ccedil;akan A.\u0026Ccedil;ağirici U. Long-Term Outcomes and Course of Compensatory Sweating after Endoscopic Sympathicotomy. Thorac Cardiovasc Surg. 2022;70(2):167-72.\u003c/li\u003e\n\u003cli\u003eJL H, JR O.KB F. Spirometric reference values from a sample of the general U.S. population. American journal of respiratory and critical care medicine. 1999;159(1):179-87.\u003c/li\u003e\n\u003cli\u003eShabat S, Furman D, Kupietzky A, Srour B, Mordechai-Heyn T, Grinbaum R, et al. Long-term Outcomes of Endoscopic Thoracoscopic Sympathectomy for Primary Focal Palmar Hyperhidrosis: High Patient Satisfaction Rates Despite Significant Compensatory Hyperhidrosis. Surg Laparosc Endosc Percutan Tech. 2022;32(6):730-35.\u003c/li\u003e\n\u003cli\u003eSolish N, Bertucci V, Dansereau A, Hong HC, Lynde C, Lupin M, et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg. 2007;33(8):908-23.\u003c/li\u003e\n\u003cli\u003eWade R, Jones-Diette J, Wright K, Layton AM.Woolacott N. Hyperhidrosis quality of life measures: review and patient perspective. J Dermatolog Treat. 2019;30(3):303-08.\u003c/li\u003e\n\u003cli\u003eDu X, Zhu X, Wang T, Hu X, Lin P, Teng Y, et al. Compensatory hyperhidrosis after different surgeries at the same sympathetic levels: a meta-analysis. Ann Transl Med. 2018;6(11):203.\u003c/li\u003e\n\u003cli\u003eBryant AS.Cerfolio RJ. Satisfaction and compensatory hyperhidrosis rates 5 years and longer after video-assisted thoracoscopic sympathotomy for hyperhidrosis. J Thorac Cardiovasc Surg. 2014;147(4):1160-63.e1.\u003c/li\u003e\n\u003cli\u003eVasconcelos-Castro S, Soares-Oliveira M, Tuna T.Borges-Dias M. Thoracoscopic sympathotomy for palmar hyperhidrosis: How young is too young? J Pediatr Surg. 2020;55(11):2362-65.\u003c/li\u003e\n\u003cli\u003eBell D, Jedynak J.Bell R. Predictors of outcome following endoscopic thoracic sympathectomy. ANZ J Surg. 2014;84(1-2):68-72.\u003c/li\u003e\n\u003cli\u003eBaumgartner FJ, Reyes M, Sarkisyan GG, Iglesias A.Reyes E. Thoracoscopic sympathicotomy for disabling palmar hyperhidrosis: a prospective randomized comparison between two levels. Ann Thorac Surg. 2011;92(6):2015-9.\u003c/li\u003e\n\u003cli\u003eAstman N, Friedberg I, Wikstrom JD, Derazne E, Pinhas-Hamiel O, Afek A, et al. The association between obesity and hyperhidrosis: A nationwide, cross-sectional study of 2.77 million Israeli adolescents. J Am Acad Dermatol. 2019;81(2):624-27.\u003c/li\u003e\n\u003cli\u003ede Campos JR, Wolosker N, Takeda FR, Kauffman P, Kuzniec S, Jatene FB.de Oliveira SA. The body mass index and level of resection: predictive factors for compensatory sweating after sympathectomy. Clin Auton Res. 2005;15(2):116-20.\u003c/li\u003e\n\u003cli\u003eAlkosha HM, Mohammed MIR, Abuelnasr T.Amen MM. Predictors of Compensatory Sweating Following Video-Assisted Thoracoscopic Sympathectomy in Primary Palmar Hyperhidrosis. World Neurosurg. 2023.\u003c/li\u003e\n\u003cli\u003eZhang W, Wei Y, Jiang H, Xu J.Yu D. T3 versus T4 thoracoscopic sympathectomy for palmar hyperhidrosis: a meta-analysis and systematic review. J Surg Res. 2017;218:124-31.\u003c/li\u003e\n\u003cli\u003eCerfolio RJ, De Campos JR, Bryant AS, Connery CP, Miller DL, DeCamp MM, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011;91(5):1642-8.\u003c/li\u003e\n\u003cli\u003eWolosker N, Leiderman DBD, de Campos JRM, Kauffman P, Tedde ML, Yazbek G.Puech-Le\u0026atilde;o P. Number of Preoperative Hyperhidrosis Sites Does Not Affect the Sympathectomy Postoperative Results and Compensatory Hyperhidrosis Occurrence. Thorac Cardiovasc Surg. 2019;67(5):407-14.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 558px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003ePatient characteristics and operative data of patients who underwent ETS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal (N=138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-CH group\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e=\u0026nbsp;29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCH group\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e= 109)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge, years, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.50 (17.00-25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.00 (16.00-24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.00 (17.00-25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGender, No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65 (47.10)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (55.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49 (44.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e73 (52.90)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (44.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 (55.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI, kg/m2, Mean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.59 (2.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.70 (2.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.82 (3.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSmoking, No.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e111 (80.43)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (86.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e86 (78.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27 (19.57)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (13.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23 (21.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOnset age \u003csup\u003ea\u003c/sup\u003e, year, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.00 (7.00-10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.00 (6.00-9.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.00 (7.00-10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePreoperative treatment,\u0026nbsp;No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWithout treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e107 (77.54)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19 (65.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88 (80.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWith treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31 (22.46)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (34.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21 (19.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFamily history,\u0026nbsp;No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e93 (67.39)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19 (65.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74 (67.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45 (32.61)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (34.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35 (32.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLevel of surgery,\u0026nbsp;No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral R3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e93 (67.39)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (62.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75 (68.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral R4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45 (32.61)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (37.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (31.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOperation time, min, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39.50 (30.00-48.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39.00 (30.00-45.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.00 (30.00-50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 558px;\"\u003e\n \u003cp\u003eAbbreviations: CH, compensatory hyperhidrosis; IQR, interquartile range; SD, standard deviation; BMI, body mass index; R3, third rib level; R4, fourth rib level; ETS, endoscopic thoracic sympathectomy.\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eOnset age refers to the time of occurrence of primary hand hyperhidrosis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Univariate analysis for compensatory hyperhidrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.04 (0.97-1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.51 (0.66-3.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.15 (0.99-1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.67 (0.53-5.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOnset age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.99 (0.88-1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePreoperative treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWithout treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWith treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.45 (0.18-1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFamily history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.90 (0.38-2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLevel of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral R3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral R4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.74 (0.32-1.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOperation time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.01 (0.98-1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eHDSS scores of compensatory hyperhidrosis across different postoperative periods\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\"\u003e\n \u003cp\u003eHDSS score number of\u0026nbsp;patients\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003ePairwise comparison\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003ePostoperative\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePeriod, No.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22\u0026nbsp;(26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59\u0026nbsp;(71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.69 \u0026plusmn;0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21\u0026nbsp;(25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55\u0026nbsp;(66.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u0026nbsp;(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u0026nbsp;(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.77 \u0026plusmn;0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u0026nbsp;years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u0026nbsp;(24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45\u0026nbsp;(54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u0026nbsp;(19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u0026nbsp;(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.00\u0026plusmn;0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003eBaseline and surgical characteristics of patients with compensatory hyperhidrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-Worsened group\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e=\u0026nbsp;65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWorsened group\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e= 18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge, years, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.00 (17.00-25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.00 (17.00-27.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.799\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGender, No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (38.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (38.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (61.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (61.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI, kg/m2, Mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.91 (3.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.79 (1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSmoking, No.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51 (78.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (77.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (21.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (22.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOnset age \u003csup\u003ea\u003c/sup\u003e, year, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.00 (7.00-10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.00 (6.00-8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePreoperative treatment,\u0026nbsp;No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWithout treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54 (83.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (77.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWith treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (16.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (22.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFamily history,\u0026nbsp;No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47 (72.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (72.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (27.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (27.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLevel of surgery,\u0026nbsp;No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral R3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49 (75.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (44.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral R4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (24.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (55.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOperation time, min, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38.00 (30.00-50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.00 (25.00-54.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.982\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDuration \u003csup\u003eb\u003c/sup\u003e, day, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.00 (14.00-60.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60.00 (30.00-360.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber of affected areas \u003csup\u003ec\u003c/sup\u003e, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.00 (2.00-4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.00 (1.00-3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003eAbbreviations: CH, compensatory hyperhidrosis; IQR, interquartile range; SD, standard deviation; BMI, body mass index; R3, third rib level; R4, fourth rib level; ETS, endoscopic thoracic sympathectomy.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eOnset age refers to the time of occurrence of primary hand hyperhidrosis; \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eDuration refers to the period since the onset of compensatory sweating; \u003csup\u003ec\u0026nbsp;\u003c/sup\u003eNumber of affected areas refers to the sites involved in compensatory hyperhidrosis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5\u0026nbsp;\u003c/strong\u003eUnivariate and multivariable analyses for the worsening of compensatory hyperhidrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;multivariable analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.05 (0.98-1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.98 (0.34-2.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.88 (0.73-1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.04 (0.30-3.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOnset age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00 (0.85-1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePreoperative treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.606\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWithout treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWith treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.40 (0.39-5.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFamily history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.994\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00 (0.31-3.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLevel of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral R3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral R4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.83 (1.29-11.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.28 (1.27-15.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOperation time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.01 (0.97-1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDuration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00 (1.00-1.01）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.00 (1.00-1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber of affected areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt;=3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.19 (0.06-0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.19 (0.05-0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"compensatory hyperhidrosis, endoscopic thoracic sympathectomy, primary palmar hyperhidrosis, HDSS score","lastPublishedDoi":"10.21203/rs.3.rs-5894496/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5894496/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCompensatory hyperhidrosis (CH) is a common complication after endoscopic thoracic sympathectomy (ETS) for hyperhidrosis. Despite its prevalence, long-term data on CH progression and associated risk factors are scarce. This study evaluates the risk factors and progression of CH during a 5-year follow-up period.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study retrospectively analyzed 138 patients with primary palmar hyperhidrosis (PPH) who underwent endoscopic thoracic sympathectomy between January 2014 and December 2019. All patients underwent bilateral single-port thoracoscopic sympathectomy and were followed up at 1, 3, and 5 years postoperatively. The severity of postoperative sweating was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with the development and progression of CH.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 138 patients were included in the study, with 78.9% reporting the occurrence of CH after surgery and 23.8% of them experiencing severe CH. HDSS scores increased over the 5 years postoperatively, with symptoms worsening. Further analysis revealed that bilateral R4-level sympathectomy significantly increased the risk of CH progression (OR\u0026thinsp;=\u0026thinsp;4.28, 95% CI: 1.27\u0026ndash;15.60, P\u0026thinsp;=\u0026thinsp;0.021) while having three or more affected areas was identified as a protective factor (OR\u0026thinsp;=\u0026thinsp;0.19, 95% CI: 0.05\u0026ndash;0.63, P\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study found that compensatory hyperhidrosis is relatively common in patients undergoing ETS, and symptoms may progressively worsen over time. The level of sympathetic nerve resection and the number of affected areas are key predictive factors for worsening symptoms.\u003c/p\u003e","manuscriptTitle":"Compensatory Hyperhidrosis Following Endoscopic Thoracic Sympathectomy: A 5-Year Follow-Up Study of Risk Factors and Symptom Progression","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-03 09:16:29","doi":"10.21203/rs.3.rs-5894496/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-13T14:55:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-22T19:17:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-11T01:48:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237222942732510719669137835235093103665","date":"2025-06-09T15:22:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-06T16:01:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221395367805516167329258090981967951929","date":"2025-06-06T14:07:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"141186019853611341557454967083848158393","date":"2025-06-03T01:21:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T13:37:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-27T13:10:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-27T13:09:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-01-24T09:43:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a5674c3c-dd11-4876-b435-10b94f4adb48","owner":[],"postedDate":"February 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:12:10+00:00","versionOfRecord":{"articleIdentity":"rs-5894496","link":"https://doi.org/10.1186/s13019-025-03720-3","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2025-12-08 15:58:56","publishedOnDateReadable":"December 8th, 2025"},"versionCreatedAt":"2025-02-03 09:16:29","video":"","vorDoi":"10.1186/s13019-025-03720-3","vorDoiUrl":"https://doi.org/10.1186/s13019-025-03720-3","workflowStages":[]},"version":"v1","identity":"rs-5894496","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5894496","identity":"rs-5894496","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}