Outcomes after major surgery in patients with myasthenia gravis: A nationwide matched cohort study

Chang, Yi Wen; Chou, Yueh Ching; Yeh, Chun Chieh; Hu, Chaur Jong; Hung, Chih Jen; Lin, Chao-Shun; Chen, Ta Liang; Liao, Chien Chang

doi:10.1371/journal.pone.0180433

Cited by 13 publications

(17 citation statements)

References 39 publications

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“…Because the majority of patients undergoing total joint replacement are adults, low rates of malignant hyperthermia in this population are expected. The increased occurrence of systemic complications in patients with MG aligns partially with the results of previous studies (Chang et al 2017, Cichos et al 2019. Similar to the findings by Chang et al (2017), MG patients experienced higher rates of postoperative pneumonia and sepsis (Chang et al 2017).…”

Section: Discussionsupporting

confidence: 89%

Increased rate of complications in myasthenia gravis patients following hip and knee arthroplasty: a nationwide database study in the PearlDiver Database on 257,707 patients

Sherman

Ofa

et al. 2021

Acta Orthopaedica

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Background and purpose — The increasing prevalence of total hip arthroplasty (THA) and total knee arthroplasty (TKA) within the growing elderly population is translating into a larger number of patients with neuromuscular conditions such as myasthenia gravis (MG) receiving arthroplasty. We compared systemic and joint complications following a THA or TKA between patients with MG and patients without MG. Patients and methods — Patient records were queried from PearlDiver (Pearl Diver Inc, Fort Wayne, IN, USA), an administrative claims database, using ICD-9/ICD-10 and Current Procedural Terminology codes. In-hospital and 90-day post-discharge rates of systemic and joint complications were compared between the 2 cohorts. Results — 372 patients with MG and 249,428 patients without MG who received a THA or TKA were included in the study. At 90 days post-discharge, MG patients exhibited exhibited between 1.6 and 15% higher rates of systemic complications, including cerebrovascular event, pneumonia, respiratory failure, sepsis, myocardial infarction, acute renal failure, anemia, and deep vein thrombosis (all p < 0.001). The same results were also found during the in-hospital time period. 90-day incidence of aseptic loosening was the only joint complication with significantly increased odds risk for the MG cohort (OR 5; 95% CI 2–12). Interpretation — Patients with MG exhibited significantly higher risk for multiple systemic complications during the index hospital stay and in the acute post-discharge setting.

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Section: Discussionsupporting

confidence: 89%

Increased rate of complications in myasthenia gravis patients following hip and knee arthroplasty: a nationwide database study in the PearlDiver Database on 257,707 patients

Sherman

Ofa

et al. 2021

Acta Orthopaedica

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“…The burden of surgery is particularly relevant given that these patients are experiencing a second surgical procedure (possibly major surgery) against a background of the severe disabling symptoms of refractory MG with the complicating factor of a potentially higher risk of peri- and postoperative events. 79,80 Chang and colleagues reported that postoperative AEs were significantly increased in patients with MG who had a history of hospitalization for MG, thymectomy, emergency care for MG, or short-term immunotherapy (IVIg and plasmapheresis); 80 these are all factors associated with refractory MG, as detailed above. Furthermore, postoperative complications can arise with any type of surgery in patients with refractory MG. 80…”

Section: Burden Of Refractory Myasthenia Gravismentioning

confidence: 97%

“…79,80 Chang and colleagues reported that postoperative AEs were significantly increased in patients with MG who had a history of hospitalization for MG, thymectomy, emergency care for MG, or short-term immunotherapy (IVIg and plasmapheresis); 80 these are all factors associated with refractory MG, as detailed above. Furthermore, postoperative complications can arise with any type of surgery in patients with refractory MG. 80…”

Section: Burden Of Refractory Myasthenia Gravismentioning

confidence: 97%

Understanding the burden of refractory myasthenia gravis

Schneider‐Gold

Hagenacker

Melzer

et al. 2019

Ther Adv Neurol Disord

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Myasthenia gravis (MG) is an autoantibody-mediated disease that compromises the acetylcholine receptors or associated structures of the postsynaptic membrane of the neuromuscular junction. This leads to impaired neuromuscular transmission and subsequent fluctuating fatigability and weakness of ocular, bulbar, and limb skeletal muscles. Over the past few decades, there have been significant advances in our understanding of the disease pathophysiology and improvements in prognosis due to intensive care medicine and immunomodulation. Despite this, an estimated 10–20% of patients with MG do not achieve an adequate response, are intolerant to conventional treatment, or require chronic treatment with intravenous immunoglobulins or plasma separation procedures. Such patients are regarded as having MG that is ‘refractory’ to treatment and may represent a distinct clinical subgroup. Because the majority of patients with MG have well-controlled disease, the burden of illness in the minority with refractory disease is poorly understood and may be underestimated. However, clinically these patients are liable to experience extreme fatigue, considerable disability owing to uncontrolled symptoms, and frequent myasthenic crises and hospitalizations. Both acute adverse effects and an increased risk of comorbidity from treatment regimens may contribute to reduced quality of life. As yet, little is known concerning the impact of refractory MG on mental health and health-related quality of life. This review aims to highlight the burden of disease and unmet needs in patients with refractory MG.

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“…12 Pneumonia, dementia, and thromboembolic disease are more prevalent in patients with PD. 13 –15 Additionally, sedentary patients can become osteoporotic, which may contribute to poor outcomes following fusion. 3,16 Kaspar et al 17 published a case series that identified aspiration pneumonia—a condition for which PD patients are at increased risk—as a major cause of mortality in the perioperative period.…”

Section: Discussionmentioning

confidence: 99%

Matched Cohort Analysis of Elective Lumbar Spinal Fusion in Patients With and Without Parkinson’s Disease: In-hospital Complications, Length of Stay, and Hospital Charges

Kleiner

Boulos

Eltorai

et al. 2018

Global Spine Journal

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Study Design: Retrospective cohort. Objectives: Parkinson's disease (PD) is a neurodegenerative condition associated with significant morbidity and mortality. PD patients often develop spinal conditions and are known to have high complication rates following surgery. This study evaluated the outcomes of lumbar fusion surgery in patients with PD using a large, public, national database. Methods:The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) was used to identify elective lumbar spinal fusion patients with and without PD for the years 2000 to 2012. PD patients were matched with non-PD controls for comorbidity and age using propensity score matching. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort.Results: A total of 231 351 elective lumbar fusion patients were examined, of which 1332 had PD. Before matching, elective lumbar fusion patients with PD were significantly older (P < .001) and more likely male (P < .001) compared with non-PD patients. In the matched cohort, PD was associated with increased length of stay (6.91 vs 5.78 days) (P < .001) and total hospital charges ($129 212.40 vs $110 324.40) (P < .001). There was no significant difference in overall in-hospital complication rate between PD patients and matched non-PD patients (22.3% vs 21.4%) (P ¼ .524).Conclusions: Analysis demonstrated significant increases in length and cost of hospitalization for elective lumbar spinal fusion in patients with PD. However, inpatient complication rates in PD patients were not significantly increased. As a growing number of PD patients undergo elective spine surgery, further studies are needed to optimize operative planning. Further study is needed to assess the long-term outcomes of lumbar spinal fusion in PD.

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Outcomes after major surgery in patients with myasthenia gravis: A nationwide matched cohort study

Cited by 13 publications

References 39 publications

Increased rate of complications in myasthenia gravis patients following hip and knee arthroplasty: a nationwide database study in the PearlDiver Database on 257,707 patients

Increased rate of complications in myasthenia gravis patients following hip and knee arthroplasty: a nationwide database study in the PearlDiver Database on 257,707 patients

Understanding the burden of refractory myasthenia gravis

Matched Cohort Analysis of Elective Lumbar Spinal Fusion in Patients With and Without Parkinson’s Disease: In-hospital Complications, Length of Stay, and Hospital Charges

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