Guillain-Barré syndrome triggered by surgery in a Chinese population: a multicenter retrospective study

Abstract

Background Surgery is a potential trigger of Guillain-Barré syndrome (GBS), a disorder which leads to an autoimmune-mediated attack of peripheral nerves. The present study was designed to explore clinical features of post-surgical GBS compared with those of general GBS in order to provide better clinical advice to patients undergoing surgery. Methods The medical records of GBS patients who were seen at 31 tertiary hospitals in southern China between January 1, 2013 and September 30, 2016 were retrospectively analyzed. Post-surgical GBS was defined as symptoms of GBS within 6 weeks after surgery. Clinical features of post-surgical GBS are described and are compared with general GBS. Results Among the 1001 GBS patient cases examined in this study, 45 (4.5%) patient cases exhibited symptoms of GBS within 6 weeks of undergoing surgery. Within this group, 36 (80.0%) patients developed initial symptoms of limb weakness. The average interval between surgery and symptom onset was 13.31 days. The most common type of surgery which triggered GBS was orthopedic surgery, followed by neurological surgery. Compared to general GBS, post-surgical GBS was characterized by a higher proportion of severe patients (Hughes functional grading scale (HFGS) score ≥ 3) upon admission and at nadir, higher HFGS scores at discharge, and longer hospital stays. Post-surgical GBS patients also had a significantly higher frequency of the acute motor axonal neuropathy subtype (37.9 vs. 14.2, respectively; P = 0.001). Conclusion Surgery is probably a potential trigger factor for GBS, especially orthopedic surgery. Infections secondary to surgery may play a role. The possibility of preceding (post-operative) infections was not excluded in this study. Clinical presentation of post-surgical GBS is characterized by a more severe course and poorer prognosis, and should be closely monitored. Trial registration chicTR-RRc-17,014,152.

Guillain–Barre Syndrome following lower segment caesarean section under spinal anesthesia: A case report

“…Post-surgical GBS patients have high HFGS at admission, at nadir and at discharge and a longer duration of hospital stay. 9 Our patient being completely bedridden during the presentation was also in Grade 4 HFGS. Median duration from surgery to onset of symptom is 15 days, 8 but it has been documented to occur as early as 5 h after surgery.…”

“…The restoration of cellular immunity, which had been adaptively repressed throughout pregnancy, is considered to cause or aggravate GBS during the postpartum period 10,11 . Besides it, etiology of post‐surgical GBS are release of antigens during surgery sensitizing immune system towards development of autoimmunity for peripheral nerve antigens, cell‐mediated immunosuppression, neuroendocrine axis activation, transfusion possibly causing sub‐clinical infection leading to cross‐reactive antibodies, inflammation resulting from damage to blood vessels, spinal cord ischemia, hemorrhage, and direct nerve injury 8,9,12–15 …”

Letter to the Editor: Guillain-Barré Syndrome Needs to Be Considered as a Cause of Idiopathic Bilateral Vocal Fold Paralysis

“…However, surgery is well known as a potential trigger for GBS. 8 9 Its exact mechanism is not yet known, but autoimmunization against antigens released during surgery and temporary immunosuppression after surgery are thought to induce autoimmune responses to peripheral nerves. 8 9 Post-surgical GBS most often occurs within 2 weeks after surgery, and the most common type of surgery to trigger GBS is orthopedic surgery.…”

“… 8 9 Its exact mechanism is not yet known, but autoimmunization against antigens released during surgery and temporary immunosuppression after surgery are thought to induce autoimmune responses to peripheral nerves. 8 9 Post-surgical GBS most often occurs within 2 weeks after surgery, and the most common type of surgery to trigger GBS is orthopedic surgery. 8 Therefore, considering GBS as a potential cause of bilateral VFP in this case is an important issue considering the patient’s recent orthopedic surgical history.…”

“… 8 9 Post-surgical GBS most often occurs within 2 weeks after surgery, and the most common type of surgery to trigger GBS is orthopedic surgery. 8 Therefore, considering GBS as a potential cause of bilateral VFP in this case is an important issue considering the patient’s recent orthopedic surgical history.…”