Outcomes After Major Surgery For Patients With Myasthenia Gravis

A couple of months ago I came close to having a total knee replacement but decided against it because of my myasthenia gravis. I just thought it was too risky. My symptoms are pretty much under control and I count myself among those MG patients that have a "relatively normal lifestyle." But I've worked hard to keep it under control and I didn't want to risk a setback. There are plenty of stories on the internet about MG patients having major surgery that worked out well and others that didn't. I just didn't want to take the chance.  

Today I found a study (below) that compared the outcomes of myasthenia gravis patients to those without the disease. If you're doing research on the subject, thinking about having an operation, you might find it helpful. There is a link at the bottom of this page that will take you to the detailed version of research complete with graphs.

 

Objective

To validate the comprehensive features of adverse outcomes after surgery for patients with myasthenia gravis.

Methods

Using 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.

Results

Compared 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.

Conclusions

Patients 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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