Abstract
BackgroundTo explore the risk factors for prolonged ventilation after thymectomy in patients with thymoma associated with myasthenia gravis (TAMG).MethodsWe reviewed the records of 112 patients with TAMG after thymectomy between January 2010 and December 2019 in Peking University People’s Hospital. Demographic, pathological, preoperative data and the Anesthesia, surgery details were assessed with multivariable logistic regression analysis to predict the risk of prolonged ventilation after thymectomy. A nomogram to predict the probability of post-thymectomy ventilation was constructed with R software. Discrimination and calibration were employed to evaluate the performance of the nomogram.ResultsBy multivariate analysis, male, low vital capacity (VC), Osserman classification (IIb, III, IV), total intravenous anesthesia, and long operation time were identified as the risk factors and entered into the nomogram. The nomogram showed a robust discrimination, with an area under the receiver operating characteristic curve (AUC) of 0. 835 (95% confidence interval [CI], 0.757–0.913). The calibration plot indicated that the nomogram-predicted probabilities compared very well with the actual probabilities (Hosmer–Lemeshow test: P = 0.921).ConclusionThe nomogram is a valuable predictive tool for prolonged ventilation after thymectomy in patients with TAMG.
Highlights
Myasthenia gravis (MG) is an acquired autoimmune disease characterized by the weakness of skeletal muscle induced by neuromuscular connection disorder
Leventhal et al [7] firstly proposed a preoperative scoring system to predict the need for postoperative ventilation in myasthenic patients after transsternal thymectomy, which consists of duration of MG, history of chronic respiratory diseases, the basic dose of brombistigmine ≥ 750 mg per day, and vital capacity less than 2.0 litters
We retrospectively reviewed data from a tertiary teaching hospital in mainland China to summary the characteristics of patients with thymoma associated with myasthenia gravis (TAMG), to explore the preoperative and intraoperative risk factors associated with prolonged mechanical ventilation after thymectomy and toconstructed a risk assessment nomogram model
Summary
Myasthenia gravis (MG) is an acquired autoimmune disease characterized by the weakness of skeletal muscle induced by neuromuscular connection disorder. Leventhal et al [7] firstly proposed a preoperative scoring system to predict the need for postoperative ventilation in myasthenic patients after transsternal thymectomy, which consists of duration of MG, history of chronic respiratory diseases, the basic dose of brombistigmine ≥ 750 mg per day, and vital capacity less than 2.0 litters. Both Grant et al [8] and Gracey et al [9] failed to substantiate this predictive model, and though the severity of myasthenia, the history of myasthenic crisis(MC), and the presence of thymus may be more meaningful in predicting the need for post-thymectomy ventilation. To explore the risk factors for prolonged ventilation after thymectomy in patients with thymoma associated with myasthenia gravis (TAMG)
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