Abstract | OBJECTIVES: Postoperative myasthenic crisis ( POMC) is one of the serious complications after extended thymectomy for patients with myasthenia gravis (MG). This study aims to clarify the risk factors of POMC occurrence. METHODS: The clinical data of 55 MG patients (25 male, 30 female; median age, 51 years) who underwent extended thymectomy at Kyoto University from 2000 to 2013 were retrospectively reviewed. Surgical outcomes and pre- and perioperative predictive factors of POMC were analysed. RESULTS: The preoperative Myasthenia Gravis Foundation of America stage was I, II, III and IV in 24, 22, 8 and 1 patients, respectively. Ten patients (18.2%) developed POMC; 6 required prolonged intubation over 24 h and 4 required reventilatory support. All patients were weaned after 5.6 (2-26) days of ventilator support, and were discharged. Univariate analysis revealed a correlation with a high preoperative anti- acetylcholine receptor antibody titre (P = 0.009), history of myasthenic crisis (MC) (P = 0.0004) and unstable MG after preoperative medical therapy (P = 0.003). Multivariate logistic regression analysis showed history of MC (odds ratio, 11.84; 95% confidential interval, 1.05-372; P = 0.045) and unstable MG (odds ratio, 29.45; 95% confidential interval, 2.00-1063; P = 0.013) independently predicted POMC. The surgical response rate was not significantly different between the two groups (66.7% with POMC, 85.4% without POMC; P = 0.334). CONCLUSIONS:
POMC occurred more frequently in unstable MG before surgery or in patients with a history of MC. Adequate preoperative medical therapy and perioperative care should be provided to these patients.
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Authors | Takeshi Ando, Mitsugu Omasa, Takayuki Kondo, Tetsu Yamada, Masaaki Sato, Toshi Menju, Akihiro Aoyama, Toshihiko Sato, Fengshi Chen, Makoto Sonobe, Hiroshi Date |
Journal | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
(Eur J Cardiothorac Surg)
Vol. 48
Issue 5
Pg. 705-9; discussion 709
(Nov 2015)
ISSN: 1873-734X [Electronic] Germany |
PMID | 25618314
(Publication Type: Journal Article)
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Copyright | © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. |
Topics |
- Adolescent
- Adult
- Aged
- Analysis of Variance
- Female
- Humans
- Male
- Middle Aged
- Myasthenia Gravis
(epidemiology, physiopathology, surgery)
- Postoperative Complications
(epidemiology)
- Retrospective Studies
- Risk Factors
- Thymectomy
(adverse effects)
- Treatment Outcome
- Young Adult
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