Abstract

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.

Original languageEnglish
Article numbere0180433
JournalPLoS One
Volume12
Issue number6
DOIs
Publication statusPublished - Jun 1 2017

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Myasthenia Gravis
cohort studies
Surgery
Cohort Studies
surgery
Health insurance
Logistics
immunotherapy
Immunotherapy
health insurance
septicemia
Perioperative Care
Thymectomy
Propensity Score
odds ratio
pneumonia
hemorrhage
confidence interval
National Health Programs
Emergency Medical Services

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Outcomes after major surgery in patients with myasthenia gravis : A nationwide matched cohort study. / Chang, Yi Wen; Chou, Yi Chun; Yeh, Chun Chieh; Hu, Chaur Jong; Hung, Chih Jen; Lin, Chao Shun; Chen, Ta Liang; Liao, Chien Chang.

In: PLoS One, Vol. 12, No. 6, e0180433, 01.06.2017.

Research output: Contribution to journalArticle

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abstract = "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.",
author = "Chang, {Yi Wen} and Chou, {Yi Chun} and Yeh, {Chun Chieh} and Hu, {Chaur Jong} and Hung, {Chih Jen} and Lin, {Chao Shun} and Chen, {Ta Liang} and Liao, {Chien Chang}",
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AU - Chang, Yi Wen

AU - Chou, Yi Chun

AU - Yeh, Chun Chieh

AU - Hu, Chaur Jong

AU - Hung, Chih Jen

AU - Lin, Chao Shun

AU - Chen, Ta Liang

AU - Liao, Chien Chang

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N2 - 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.

AB - 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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