Abstract
ObjectivesPatients with myasthenia gravis (MG) often benefit from thymectomy, but the optimal timing of extubation following thymectomy in these patients remains unknown. This study of MG patients compared the effect of early and late extubation following thymectomy on clinical outcome.MethodsWe performed a study of data from 96 patients with MG who received thymectomy procedures, followed by early (< 6 h) or late (> 6 h) extubation, at our institution between October 2011 and November 2017. Patient clinical and demographic characteristics, preoperative data, and postoperative clinical outcomes were analyzed. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.ResultsThe patients in the early extubation group (n = 53) and late extubation group (n = 43) had similar preoperative clinical and demographic characteristics. However, the early extubation group had a significantly longer duration of MG (24 months vs. 12 months, P < 0.013) and a lower incidence of reintubation (11.3% vs. 37.2%, P = 0.003). Postoperative pulmonary infection was significantly more common in the late extubation group (39.5% vs. 11.3%, P = 0.001; adjusted odds ratio = 6.94, 95% CI 1.24–38.97). Also, patients in the late extubation group had a longer duration of ICU stay (6.4 ± 4.0 h vs. 4.3 ± 1.8 h; P = 0.003) and had a longer adjusted duration of ICU stay by 0.93 days (95% CI 0.02–1.85).ConclusionsOur analysis of patients with MG who received thymectomy procedures indicated that early extubation was associated with improved clinical outcomes, in particular with reduced risk of postoperative pulmonary infection and reduced ICU stay.
Highlights
Myasthenia gravis (MG) is an autoimmune disorder characterized by varying degrees of weakness and fatigability of skeletal muscles due to the presence of autoantibodies directed against different components of the neuromuscular junction (NMJ) [1, 2]
Analysis of other preoperative variables indicated that 7.3% of patients had thymoma, 23% had a myasthenic crisis requiring mechanical ventilation, 35.4% used an adjunctive steroid hormone therapy, and 8.3% used an immunosuppressant therapy
Patients in the late extubation group had a longer duration of intensive care unit (ICU) stay compared with those in the early extubation group (6.4 ± 4.0 vs. 4.3 ± 1.8; P = 0.003) and had a longer adjusted duration of ICU stay by 0.93 days (Table 5)
Summary
Myasthenia gravis (MG) is an autoimmune disorder characterized by varying degrees of weakness and fatigability of skeletal muscles due to the presence of autoantibodies directed against different components of the neuromuscular junction (NMJ) [1, 2]. Patients with thymomatous or nonthymomatous MG benefit from thymectomy. This procedure modifies the natural course of MG by eliminating receptor sites for acetylcholine, and thereby helps to reduce the autoimmune response [4]. Because of the increased use of surgery and medical costs, Verrier et al initially promoted the use of Bfast-track surgery^ in 1993 [5]. The core of fast-track surgery is early extubation, in an effort to reduce the use of a medical ventilator and nursing staff. Fast-track surgery is expected to shorten ICU stays and provide earlier hospital discharge
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
