Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis
OBJECTIVES Thymectomy plays an important role in patients with myasthenia gravis (MG). This study aimed to explore predictors of postoperative myasthenic crisis (POMC) after thymectomy and to define a predictive score of respiratory failure. METHODS The clinical data of 177 patients with MG undergoi...
Gespeichert in:
| Veröffentlicht in: | European journal of cardio-thoracic surgery 2014-04, Vol.45 (4), p.e76-e88 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e88 |
|---|---|
| container_issue | 4 |
| container_start_page | e76 |
| container_title | European journal of cardio-thoracic surgery |
| container_volume | 45 |
| creator | 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 |
| description | OBJECTIVES
Thymectomy plays an important role in patients with myasthenia gravis (MG). This study aimed to explore predictors of postoperative myasthenic crisis (POMC) after thymectomy and to define a predictive score of respiratory failure.
METHODS
The clinical data of 177 patients with MG undergoing thymectomy from January 1995 to December 2011 were retrospectively reviewed. The following factors were analysed in relation to the occurrence of myasthenic crisis: gender, age, body mass index (BMI), anti-acetylcholine receptor-antibody level, bulbar symptoms, comorbidities, duration of symptoms, Osserman-stage, Myasthenia Gravis Foundation of America (MGFA) stage, history of myasthenic crisis, use of immoglobulins or plasmapheresis, kind of therapy, spirometric and blood gas parameters, histology, kind of surgery, non-myasthenic complications and duration of intubation.
RESULTS
Twenty-two patients experienced postoperative respiratory failure after thymectomy. Univariate analysis revealed a correlation with age >60 years (odds ratio (OR) = 1.79, 95% confidence interval (CI) = 1.04-6.78; P = 0.040); Osserman-stage (IIB- OR = 5.16, 95% CI = 1.10-24.18; P = 0.037, III-IV- OR = 8.75, 95% CI = 1.53-50.05; P = 0.015); bulbar symptoms (OR = 7.42, 95% CI = 1.67-32.84; P = 0.008); BMI >28 (OR = 3.99, 95% CI = 1.58-10.03; P = 0.003); preoperative plasmapheresis (OR = 2.97, 95% CI = 1.18-14.04; P = 0.021); duration of symptoms >2 years (OR = 4.00, 95% CI = 1.09-14.762; P = 0.036); extended surgery (OR = 2.52, 95% CI = 1.02-6.22; P = 0.045); lung (OR = 4.05, 95% CI = 1.44-11.42; P = 0.008), pericardial (OR = 3.78, 95% CI = 1.45-9.82; P = 0.006) or pleural resection (OR = 3.23, 95% CI = 1.30-8.03; P = 0.012); Vital Capacity % 40 mmHg (OR = 3.76, 95% CI = 1.12-12.68; P = 0.032). Multivariate logistic regression analysis showed that Osserman-stage (IIB- OR = 5.69, 95% CI = 1.09-29.69; P = 0.039 (III-IV- OR = 11.33, 95% CI = 1.67-76.72; P = 0.013), BMI >28 (OR = 3.65, 95% CI = 1.10-12.15; P = 0.035), history of myasthenic crisis (OR = 24.10, 95% CI = 2.34-248.04; P = 0.007), duration of symptoms >2 years (OR = 5.94, 95% CI = 1.12-31.48; P = 0.036) and lung resection (OR = 8.48, 95% CI = 2.18-32.97; P = 0.002) independently predict POMC. Excluding history of preoperative myasthenic crisis (statistically associated with Osserman-stage), we built a scoring system according to the OR of Osserman-stage (I-IIA, IIB, III- |
| doi_str_mv | 10.1093/ejcts/ezt641 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1508682300</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ejcts/ezt641</oup_id><sourcerecordid>1508682300</sourcerecordid><originalsourceid>FETCH-LOGICAL-c427t-3f75d26ff0dee3079565fdc866095e5d5bc6d2ade6d5e067419ca267d60709573</originalsourceid><addsrcrecordid>eNp9kDtPwzAURi0EoqWwMSNvMBB6ncR2woYqXlIlliKxRa59Q10ldbCTSuXXE9rSkem-jo6uPkIuGdwxyJMxLnUbxvjdipQdkSHLZBLJJP047ntgEMk8hQE5C2EJACKJ5SkZxCmPOQMxJHq22NSoW1dvqF3ReqNCu8CVVfTTq7UN97TxrnFBVbR0nqp-RGN1a9dIg3YeqStpf29dg15t1weHptrbYMM5OSlVFfBiX0fk_elxNnmJpm_Pr5OHaaTTWLZRUkpuYlGWYBATkDkXvDQ6EwJyjtzwuRYmVgaF4QhCpizXKhbSCJA9IZMRudl5-5e_OgxtUdugsarUCl0XCsYhE1mcAPTo7Q7V3oXgsSwab2vlNwWD4jfWYhtrsYu1x6_25m5eoznAfzn2wPUOcF3zv-oH6giEjg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1508682300</pqid></control><display><type>article</type><title>Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>OBJECTIVES
Thymectomy plays an important role in patients with myasthenia gravis (MG). This study aimed to explore predictors of postoperative myasthenic crisis (POMC) after thymectomy and to define a predictive score of respiratory failure.
METHODS
The clinical data of 177 patients with MG undergoing thymectomy from January 1995 to December 2011 were retrospectively reviewed. The following factors were analysed in relation to the occurrence of myasthenic crisis: gender, age, body mass index (BMI), anti-acetylcholine receptor-antibody level, bulbar symptoms, comorbidities, duration of symptoms, Osserman-stage, Myasthenia Gravis Foundation of America (MGFA) stage, history of myasthenic crisis, use of immoglobulins or plasmapheresis, kind of therapy, spirometric and blood gas parameters, histology, kind of surgery, non-myasthenic complications and duration of intubation.
RESULTS
Twenty-two patients experienced postoperative respiratory failure after thymectomy. Univariate analysis revealed a correlation with age >60 years (odds ratio (OR) = 1.79, 95% confidence interval (CI) = 1.04-6.78; P = 0.040); Osserman-stage (IIB- OR = 5.16, 95% CI = 1.10-24.18; P = 0.037, III-IV- OR = 8.75, 95% CI = 1.53-50.05; P = 0.015); bulbar symptoms (OR = 7.42, 95% CI = 1.67-32.84; P = 0.008); BMI >28 (OR = 3.99, 95% CI = 1.58-10.03; P = 0.003); preoperative plasmapheresis (OR = 2.97, 95% CI = 1.18-14.04; P = 0.021); duration of symptoms >2 years (OR = 4.00, 95% CI = 1.09-14.762; P = 0.036); extended surgery (OR = 2.52, 95% CI = 1.02-6.22; P = 0.045); lung (OR = 4.05, 95% CI = 1.44-11.42; P = 0.008), pericardial (OR = 3.78, 95% CI = 1.45-9.82; P = 0.006) or pleural resection (OR = 3.23, 95% CI = 1.30-8.03; P = 0.012); Vital Capacity % <80% (OR = 0.20, 95% CI = 0.05-0.82; P = 0.025) and PaCO2 >40 mmHg (OR = 3.76, 95% CI = 1.12-12.68; P = 0.032). Multivariate logistic regression analysis showed that Osserman-stage (IIB- OR = 5.69, 95% CI = 1.09-29.69; P = 0.039 (III-IV- OR = 11.33, 95% CI = 1.67-76.72; P = 0.013), BMI >28 (OR = 3.65, 95% CI = 1.10-12.15; P = 0.035), history of myasthenic crisis (OR = 24.10, 95% CI = 2.34-248.04; P = 0.007), duration of symptoms >2 years (OR = 5.94, 95% CI = 1.12-31.48; P = 0.036) and lung resection (OR = 8.48, 95% CI = 2.18-32.97; P = 0.002) independently predict POMC. Excluding history of preoperative myasthenic crisis (statistically associated with Osserman-stage), we built a scoring system according to the OR of Osserman-stage (I-IIA, IIB, III-IV), BMI (<28, ≥28), duration of symptoms (<1, 1-2, >2 years) and association with a pulmonary resection. This model helped in creating four classes with increasing risk of respiratory failure (Group I, 6%; Group II, 10%; Group III, 25%; Group IV, 50%).
CONCLUSIONS
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.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezt641</identifier><identifier>PMID: 24525106</identifier><language>eng</language><publisher>Germany: Oxford University Press</publisher><subject>Female ; Humans ; Male ; Middle Aged ; Models, Statistical ; Myasthenia Gravis - epidemiology ; Myasthenia Gravis - physiopathology ; Myasthenia Gravis - surgery ; Postoperative Complications - classification ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Respiratory Insufficiency - epidemiology ; Retrospective Studies ; Thymectomy - adverse effects ; Thymectomy - methods ; Thymectomy - statistics & numerical data</subject><ispartof>European journal of cardio-thoracic surgery, 2014-04, Vol.45 (4), p.e76-e88</ispartof><rights>The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-3f75d26ff0dee3079565fdc866095e5d5bc6d2ade6d5e067419ca267d60709573</citedby><cites>FETCH-LOGICAL-c427t-3f75d26ff0dee3079565fdc866095e5d5bc6d2ade6d5e067419ca267d60709573</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24525106$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leuzzi, Giovanni</creatorcontrib><creatorcontrib>Meacci, Elisa</creatorcontrib><creatorcontrib>Cusumano, Giacomo</creatorcontrib><creatorcontrib>Cesario, Alfredo</creatorcontrib><creatorcontrib>Chiappetta, Marco</creatorcontrib><creatorcontrib>Dall'Armi, Valentina</creatorcontrib><creatorcontrib>Evoli, Amelia</creatorcontrib><creatorcontrib>Costa, Roberta</creatorcontrib><creatorcontrib>Lococo, Filippo</creatorcontrib><creatorcontrib>Primieri, Paolo</creatorcontrib><creatorcontrib>Margaritora, Stefano</creatorcontrib><creatorcontrib>Granone, Pierluigi</creatorcontrib><title>Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>OBJECTIVES
Thymectomy plays an important role in patients with myasthenia gravis (MG). This study aimed to explore predictors of postoperative myasthenic crisis (POMC) after thymectomy and to define a predictive score of respiratory failure.
METHODS
The clinical data of 177 patients with MG undergoing thymectomy from January 1995 to December 2011 were retrospectively reviewed. The following factors were analysed in relation to the occurrence of myasthenic crisis: gender, age, body mass index (BMI), anti-acetylcholine receptor-antibody level, bulbar symptoms, comorbidities, duration of symptoms, Osserman-stage, Myasthenia Gravis Foundation of America (MGFA) stage, history of myasthenic crisis, use of immoglobulins or plasmapheresis, kind of therapy, spirometric and blood gas parameters, histology, kind of surgery, non-myasthenic complications and duration of intubation.
RESULTS
Twenty-two patients experienced postoperative respiratory failure after thymectomy. Univariate analysis revealed a correlation with age >60 years (odds ratio (OR) = 1.79, 95% confidence interval (CI) = 1.04-6.78; P = 0.040); Osserman-stage (IIB- OR = 5.16, 95% CI = 1.10-24.18; P = 0.037, III-IV- OR = 8.75, 95% CI = 1.53-50.05; P = 0.015); bulbar symptoms (OR = 7.42, 95% CI = 1.67-32.84; P = 0.008); BMI >28 (OR = 3.99, 95% CI = 1.58-10.03; P = 0.003); preoperative plasmapheresis (OR = 2.97, 95% CI = 1.18-14.04; P = 0.021); duration of symptoms >2 years (OR = 4.00, 95% CI = 1.09-14.762; P = 0.036); extended surgery (OR = 2.52, 95% CI = 1.02-6.22; P = 0.045); lung (OR = 4.05, 95% CI = 1.44-11.42; P = 0.008), pericardial (OR = 3.78, 95% CI = 1.45-9.82; P = 0.006) or pleural resection (OR = 3.23, 95% CI = 1.30-8.03; P = 0.012); Vital Capacity % <80% (OR = 0.20, 95% CI = 0.05-0.82; P = 0.025) and PaCO2 >40 mmHg (OR = 3.76, 95% CI = 1.12-12.68; P = 0.032). Multivariate logistic regression analysis showed that Osserman-stage (IIB- OR = 5.69, 95% CI = 1.09-29.69; P = 0.039 (III-IV- OR = 11.33, 95% CI = 1.67-76.72; P = 0.013), BMI >28 (OR = 3.65, 95% CI = 1.10-12.15; P = 0.035), history of myasthenic crisis (OR = 24.10, 95% CI = 2.34-248.04; P = 0.007), duration of symptoms >2 years (OR = 5.94, 95% CI = 1.12-31.48; P = 0.036) and lung resection (OR = 8.48, 95% CI = 2.18-32.97; P = 0.002) independently predict POMC. Excluding history of preoperative myasthenic crisis (statistically associated with Osserman-stage), we built a scoring system according to the OR of Osserman-stage (I-IIA, IIB, III-IV), BMI (<28, ≥28), duration of symptoms (<1, 1-2, >2 years) and association with a pulmonary resection. This model helped in creating four classes with increasing risk of respiratory failure (Group I, 6%; Group II, 10%; Group III, 25%; Group IV, 50%).
CONCLUSIONS
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.</description><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Models, Statistical</subject><subject>Myasthenia Gravis - epidemiology</subject><subject>Myasthenia Gravis - physiopathology</subject><subject>Myasthenia Gravis - surgery</subject><subject>Postoperative Complications - classification</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Respiratory Insufficiency - epidemiology</subject><subject>Retrospective Studies</subject><subject>Thymectomy - adverse effects</subject><subject>Thymectomy - methods</subject><subject>Thymectomy - statistics & numerical data</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kDtPwzAURi0EoqWwMSNvMBB6ncR2woYqXlIlliKxRa59Q10ldbCTSuXXE9rSkem-jo6uPkIuGdwxyJMxLnUbxvjdipQdkSHLZBLJJP047ntgEMk8hQE5C2EJACKJ5SkZxCmPOQMxJHq22NSoW1dvqF3ReqNCu8CVVfTTq7UN97TxrnFBVbR0nqp-RGN1a9dIg3YeqStpf29dg15t1weHptrbYMM5OSlVFfBiX0fk_elxNnmJpm_Pr5OHaaTTWLZRUkpuYlGWYBATkDkXvDQ6EwJyjtzwuRYmVgaF4QhCpizXKhbSCJA9IZMRudl5-5e_OgxtUdugsarUCl0XCsYhE1mcAPTo7Q7V3oXgsSwab2vlNwWD4jfWYhtrsYu1x6_25m5eoznAfzn2wPUOcF3zv-oH6giEjg</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Leuzzi, Giovanni</creator><creator>Meacci, Elisa</creator><creator>Cusumano, Giacomo</creator><creator>Cesario, Alfredo</creator><creator>Chiappetta, Marco</creator><creator>Dall'Armi, Valentina</creator><creator>Evoli, Amelia</creator><creator>Costa, Roberta</creator><creator>Lococo, Filippo</creator><creator>Primieri, Paolo</creator><creator>Margaritora, Stefano</creator><creator>Granone, Pierluigi</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140401</creationdate><title>Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-3f75d26ff0dee3079565fdc866095e5d5bc6d2ade6d5e067419ca267d60709573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Models, Statistical</topic><topic>Myasthenia Gravis - epidemiology</topic><topic>Myasthenia Gravis - physiopathology</topic><topic>Myasthenia Gravis - surgery</topic><topic>Postoperative Complications - classification</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Respiratory Insufficiency - epidemiology</topic><topic>Retrospective Studies</topic><topic>Thymectomy - adverse effects</topic><topic>Thymectomy - methods</topic><topic>Thymectomy - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leuzzi, Giovanni</creatorcontrib><creatorcontrib>Meacci, Elisa</creatorcontrib><creatorcontrib>Cusumano, Giacomo</creatorcontrib><creatorcontrib>Cesario, Alfredo</creatorcontrib><creatorcontrib>Chiappetta, Marco</creatorcontrib><creatorcontrib>Dall'Armi, Valentina</creatorcontrib><creatorcontrib>Evoli, Amelia</creatorcontrib><creatorcontrib>Costa, Roberta</creatorcontrib><creatorcontrib>Lococo, Filippo</creatorcontrib><creatorcontrib>Primieri, Paolo</creatorcontrib><creatorcontrib>Margaritora, Stefano</creatorcontrib><creatorcontrib>Granone, Pierluigi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leuzzi, Giovanni</au><au>Meacci, Elisa</au><au>Cusumano, Giacomo</au><au>Cesario, Alfredo</au><au>Chiappetta, Marco</au><au>Dall'Armi, Valentina</au><au>Evoli, Amelia</au><au>Costa, Roberta</au><au>Lococo, Filippo</au><au>Primieri, Paolo</au><au>Margaritora, Stefano</au><au>Granone, Pierluigi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2014-04-01</date><risdate>2014</risdate><volume>45</volume><issue>4</issue><spage>e76</spage><epage>e88</epage><pages>e76-e88</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>OBJECTIVES
Thymectomy plays an important role in patients with myasthenia gravis (MG). This study aimed to explore predictors of postoperative myasthenic crisis (POMC) after thymectomy and to define a predictive score of respiratory failure.
METHODS
The clinical data of 177 patients with MG undergoing thymectomy from January 1995 to December 2011 were retrospectively reviewed. The following factors were analysed in relation to the occurrence of myasthenic crisis: gender, age, body mass index (BMI), anti-acetylcholine receptor-antibody level, bulbar symptoms, comorbidities, duration of symptoms, Osserman-stage, Myasthenia Gravis Foundation of America (MGFA) stage, history of myasthenic crisis, use of immoglobulins or plasmapheresis, kind of therapy, spirometric and blood gas parameters, histology, kind of surgery, non-myasthenic complications and duration of intubation.
RESULTS
Twenty-two patients experienced postoperative respiratory failure after thymectomy. Univariate analysis revealed a correlation with age >60 years (odds ratio (OR) = 1.79, 95% confidence interval (CI) = 1.04-6.78; P = 0.040); Osserman-stage (IIB- OR = 5.16, 95% CI = 1.10-24.18; P = 0.037, III-IV- OR = 8.75, 95% CI = 1.53-50.05; P = 0.015); bulbar symptoms (OR = 7.42, 95% CI = 1.67-32.84; P = 0.008); BMI >28 (OR = 3.99, 95% CI = 1.58-10.03; P = 0.003); preoperative plasmapheresis (OR = 2.97, 95% CI = 1.18-14.04; P = 0.021); duration of symptoms >2 years (OR = 4.00, 95% CI = 1.09-14.762; P = 0.036); extended surgery (OR = 2.52, 95% CI = 1.02-6.22; P = 0.045); lung (OR = 4.05, 95% CI = 1.44-11.42; P = 0.008), pericardial (OR = 3.78, 95% CI = 1.45-9.82; P = 0.006) or pleural resection (OR = 3.23, 95% CI = 1.30-8.03; P = 0.012); Vital Capacity % <80% (OR = 0.20, 95% CI = 0.05-0.82; P = 0.025) and PaCO2 >40 mmHg (OR = 3.76, 95% CI = 1.12-12.68; P = 0.032). Multivariate logistic regression analysis showed that Osserman-stage (IIB- OR = 5.69, 95% CI = 1.09-29.69; P = 0.039 (III-IV- OR = 11.33, 95% CI = 1.67-76.72; P = 0.013), BMI >28 (OR = 3.65, 95% CI = 1.10-12.15; P = 0.035), history of myasthenic crisis (OR = 24.10, 95% CI = 2.34-248.04; P = 0.007), duration of symptoms >2 years (OR = 5.94, 95% CI = 1.12-31.48; P = 0.036) and lung resection (OR = 8.48, 95% CI = 2.18-32.97; P = 0.002) independently predict POMC. Excluding history of preoperative myasthenic crisis (statistically associated with Osserman-stage), we built a scoring system according to the OR of Osserman-stage (I-IIA, IIB, III-IV), BMI (<28, ≥28), duration of symptoms (<1, 1-2, >2 years) and association with a pulmonary resection. This model helped in creating four classes with increasing risk of respiratory failure (Group I, 6%; Group II, 10%; Group III, 25%; Group IV, 50%).
CONCLUSIONS
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.</abstract><cop>Germany</cop><pub>Oxford University Press</pub><pmid>24525106</pmid><doi>10.1093/ejcts/ezt641</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1010-7940 |
| ispartof | European journal of cardio-thoracic surgery, 2014-04, Vol.45 (4), p.e76-e88 |
| issn | 1010-7940 1873-734X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1508682300 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Female Humans Male Middle Aged Models, Statistical Myasthenia Gravis - epidemiology Myasthenia Gravis - physiopathology Myasthenia Gravis - surgery Postoperative Complications - classification Postoperative Complications - epidemiology Postoperative Complications - etiology Respiratory Insufficiency - epidemiology Retrospective Studies Thymectomy - adverse effects Thymectomy - methods Thymectomy - statistics & numerical data |
| title | Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T08%3A12%3A00IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Thymectomy%20in%20myasthenia%20gravis:%20proposal%20for%20a%20predictive%20score%20of%20postoperative%20myasthenic%20crisis&rft.jtitle=European%20journal%20of%20cardio-thoracic%20surgery&rft.au=Leuzzi,%20Giovanni&rft.date=2014-04-01&rft.volume=45&rft.issue=4&rft.spage=e76&rft.epage=e88&rft.pages=e76-e88&rft.issn=1010-7940&rft.eissn=1873-734X&rft_id=info:doi/10.1093/ejcts/ezt641&rft_dat=%3Cproquest_cross%3E1508682300%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1508682300&rft_id=info:pmid/24525106&rft_oup_id=10.1093/ejcts/ezt641&rfr_iscdi=true |