Objective: To explore how diaphragmatic paralysis affects health-related quality of life (HRQOL) and to assess potential improvements after phrenic nerve reconstruction.

Method: A retrospective chart review using a random sample of 34 patients with symptomatic diaphragm paralysis who underwent phrenic nerve reconstruction selected from a larger cohort of 411 patients treated between 2018 and 2023. The sample size was meticulously chosen to attain 80% power in detecting medium to large effect sizes, with patients selected using systematic random sampling. HRQOL was measured using the SF-36 30 days before and 12 months after surgery.

Results: A paired sample t-test revealed statistically significant improvements from baseline in 6 of 8 subscales of the SF-36 at 12 months after surgery. The 6 subscales included: physical functioning, role-physical, role emotion, social functioning, vitality, bodily pain; mental and general health showed no significant change. Before surgery, 4 of 8 subscales were below US population norms, highlighting the burden of diaphragmatic paralysis. Following surgery, 7 of 8 subscales exceeded US norms. The findings indicate substantial enhancements in various aspects of health and well-being following the surgical intervention.

Conclusion: Diaphragmatic paralysis causes respiratory deficits that impact physical functioning and overall well-being. Phrenic nerve reconstruction aims to restore functional diaphragmatic activity, leading to significant improvements in HRQOL. Further research is warranted to validate the durability of these beneficial effects.