Short Term Postoperative Outcomes Following Thymectomy in Myasthenia Gravis Patients with or without Thymoma: A Single Center Prospective Study

Abstract

Background: Myasthenia gravis (MG) is a common post-synaptic neuromuscular junction (NMJ) disorder which results in fatigability or reversible muscular weakening of the eye lid, extraocular, bulbar, or limb muscles. The current study was conducted to observe the short term (30 days) outcome of post-thymectomy MG patients with or without thymoma. Methods: This prospective comparative study was conducted in the Department of Thoracic Surgery of Dhaka Medical College and Hospital (DMCH) from January 2023 to December 2025 over a period of 36 months. The patients were divided into 2 groups: Group-A: Myasthenia gravis with thymoma (ThMG group) and Group-B: Myasthenia gravis without thymoma (non-ThMG group). Patients were analyzed in terms of 30 days post-operative outcomes which included myasthenia crisis, requirement of post-operative plasmapheresis (PLEX), pulmonary complications, requirement of post-operative intensive care support (ICU) and ventilatory support Mean duration of hospital stay was also compered between two groups. Statistical analyses were performed using Windows-based computer software devised with Statistical Packages for Social Sciences (SPSS-27) (SPSS Inc., Chicago, IL, USA). A p-value less than 0.05 was considered statistically significant. Results: A total number of 33 patients were included in the current study. Mean age of group-A (n=15) and group-B (n=18) were 42.16 ± 7.8 years and 44±4.3 years respectively. Females were predominant in both groups (53.33% vs 55.55%) Amount of per-operative blood transfusion unit was more in group-A which was statistically significant (3.2±2.5 units vs 1.8±0.8 unit; p<0.05). Post-operative complications were more in group-A than group-B. Myasthenia crisis (53.33%) was the major complication in group–A while only 5.56% patients suffered from Myasthenia crisis in non ThMG group (p=0.001). Besides, statistically significant difference (p=0.001)) was noted between mean duration of hospital stay of both groups (21±4.6 days vs.10±3.2 days).46.67% patients needed ventilator support in group-A while only 5.56% patient required ventilator support. Post-operative plasmapheresis (PLEX) requirement was more in ThMG group and the difference was statistically significant (40% vs. 5%, p=0.001).Mortality rate was also higher in ThMG group then non-ThMG group (26.67% vs. 5.56%). Conclusion: The current study demonstrated adverse post-operative outcome in ThMG patients. The chance of developing post-operative myasthenia crisis is very high in these patients.