Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis

Leuzzi, Giovanni; Meacci, Elisa; Cusumano, Giacomo; Cesario, Alfredo; Chiappetta, Marco; Dall’Armi, Valentina; Evoli, Amelia; Costa, Roberta; Lococo, Filippo; Primieri, Paolo; Margaritora, Stefano; Granone, Pierluigi

doi:10.1093/ejcts/ezt641

Cited by 58 publications

(42 citation statements)

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“…7 We diagnosed POMC as previously described, 19 and found that 12.4% of our patients developed POMC. Though no prospective studies have yet studied POMC, numerous retrospective studies indicated that a preoperative myasthenic crisis, more advanced disease, postoperative infection, and higher dose of PYR were risk factors for POMC; the effects of thymoma or ectopic thymus, timing of surgery, higher level of anti-AchR, and blood loss during surgery are controversial.…”

Section: Discussionsupporting

confidence: 52%

Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy

Zou¹,

Lun³

et al. 2016

Medicine

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A thymectomy can ameliorate the symptoms of myasthenia gravis (MG) and prevent the progression of ocular MG (OMG) to generalized MG (GMG). However, postoperative myasthenic crisis (POMC) is a serious post-thymectomy complication. Preoperative anxiety (POA) is common but typically neglected in MG patients. The association of POA with POMC has not yet been examined.From June 2007 to December 2013, 541 cases of MG were admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). All cases underwent extended transsternal thymectomy (ETT). The clinical and pathological characteristics of these patients, including POA and POMC, were analyzed.A total of 179 patients experienced POA and 67 patients experienced POMC. Patients with POA were more likely to have POMC, a thymoma, and an ectopic thymus. Univariate analysis showed that POMC correlated with POA, presence of an ectopic thymus, dose of pyridostigmine bromide (PYR), presence of a thymoma, MGFA stage, preoperative myasthenic crisis, and postoperative pneumonia. Multivariate logistic regression analysis showed that the independent risk factors for POMC were POA, preoperative myasthenic crisis, higher dose of PYR, and postoperative pneumonia.Our results suggest that clinicians should consider the risk factors for POMC—especially preoperative anxiety—before performing a thymectomy in patients with MG.

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Section: Discussionsupporting

confidence: 52%

Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy

Zou¹,

Lun³

et al. 2016

Medicine

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“…Based on this sequence, the severity of patient disease could be deduced from patient receiving emergency care or being hospitalized. Two recent studies found that unstable myasthenia gravis before surgery, preoperative plasmapheresis, and patients with a history of myasthenic crisis have increased incidence of myasthenic crisis after surgery [34,35]. Patients with these histories might be considered more vulnerable, and this might explain the significant increase in postoperative adverse events.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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ObjectiveTo validate the comprehensive features of adverse outcomes after surgery for patients with myasthenia gravis.MethodsUsing reimbursement claims from Taiwan’s National Health Insurance Research Database, we analyzed 2290 patients who received major surgery between 2004 and 2010 and were diagnosed with myasthenia gravis preoperatively. Surgical patients without myasthenia gravis (n = 22,900) were randomly selected by matching procedure with propensity score for comparison. The adjusted odds ratios and 95% confidence intervals of postoperative adverse events associated with preoperative myasthenia gravis were calculated under the multiple logistic regressions.ResultsCompared with surgical patients without myasthenia gravis, surgical patients with myasthenia gravis had higher risks of postoperative pneumonia (OR = 2.09; 95% CI: 1.65–2.65), septicemia (OR = 1.31; 95% CI: 1.05–1.64), postoperative bleeding (OR = 1.71; 95% CI: 1.07–2.72), and overall complications (OR = 1.70; 95% CI: 1.44–2.00). The ORs of postoperative adverse events for patients with myasthenia gravis who had symptomatic therapy, chronic immunotherapy, and short-term immunotherapy were 1.76 (95% CI 1.50–2.08), 1.70 (95% CI 1.36–2.11), and 4.36 (95% CI 2.11–9.04), respectively.ConclusionsPatients with myasthenia gravis had increased risks of postoperative adverse events, particularly those experiencing emergency care, hospitalization, and thymectomy for care of myasthenia gravis. Our findings suggest the urgency of revising protocols for perioperative care for these populations.

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“…Preoperative management with IVIg or PLEX is effective for rapid improvement and is used to reduce perioperative complications including myasthenic crisis after operation . In this study, preoperative management was performed in 4 (40%) patients with MCAVT and 13 (9.6%) patients without MCAVT (Table ).…”

Section: Discussionmentioning

confidence: 99%

Predictive factors for myasthenic crisis after videoscopic thymectomy in patients with myasthenia gravis

Lee

et al. 2015

Muscle and Nerve

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Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis

Abstract: Our model facilitates the stratification of patient risk and prediction of the occurrence of POMC. Moreover, it could help to guide the anaesthesiologist's decision on the duration of intubation. Further studies based on larger series are needed to confirm these preliminary data.

Cited by 58 publications

References 20 publications

Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy

Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy

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

Predictive factors for myasthenic crisis after videoscopic thymectomy in patients with myasthenia gravis

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