Thymectomy Reduces Hospital Stay From Myasthenia Gravis With Acute Exacerbation

Researchers have identified several factors that impact length of hospital stay for patients with myasthenia gravis (MG) with acute exacerbations in a new study, the findings of which highlight the need for further analysis of the role of thymectomy for these patients.

Among the 70 patients included in the retrospective study, nearly one-fifth were intubated, which was the strongest predictor of length of stay. By characterizing factors associated with length of hospital stay for these patients, the researchers argue their findings may help elucidate gaps in acute MG management as various novel immunosuppressive treatments are being explored for the condition.

“Perhaps the most interesting finding from this data is that patients with a thymectomy spent less time in the hospital for MG exacerbation,” explained the researchers in BMC Neurology, noting that patients who had a thymectomy had a mean length of stay of 5.81 days compared with 9.53 days among patients without the procedure. “Thymectomy has already been shown to be helpful in reducing disease exacerbation and required use of prednisone/immunosuppressants. This could demonstrate another way in which thymectomy helps ameliorate disease burden.”

The researchers note that this finding adds valuable insight into individualized treatment decisions in scenarios where the role of thymectomy is not fully clear. Although current guidelines include clear recommendations for certain groups of patients—thymectomy is recommended in 10% of patients who have MG with thymoma and is recommended in nonthymomatous patients younger than age 50 who do not have MuSK or LRP4 antibodies but have either generalized MG or refractory disabling ocular MG—the decision for thymectomy is made on an individual basis due to the low quality of evidence of its benefit. Patients included in the current study fall into the weak-evidence-base bucket.

Mean length of hospital stay in the current study was 8.58 days, with average length of stay being longer for patients who received plasmapheresis. Length of stay was further lengthened if the patients received both plasmapheresis and intravenous immunoglobulins (IVIg). Data from the current study also showed that plasmapheresis was associated with a longer length of stay among patients.

“Plasmapheresis as a contributor to longer hospital stays in nonintubated patients was unsurprising because this hospital’s protocol for treating MG exacerbation with plasmapheresis is 1 session every other day for a total of 5 sessions,” commented the group. “Therefore, a course of plasmapheresis necessitates a minimum of 10 days in the hospital. The 7.09% of exacerbations treated with both plasmapheresis and IVIg likely represent those with severe refractory exacerbations, which would explain the longer average stay in these patients.”

Other factors associated with longer length of stay included male sex, not complying with maintenance regimen prior to hospitalization, and intensive care unit admission, although the latter 2 factors did not meet the threshold for significance. The length of hospital stay was nearly doubled for men compared with women, at 12.88 vs 6.63 days, and the length of stay for men reached up to 92 days compared with 33 days for women.

Reference

Ramsaroop T, Gelinas D, Kang S, Govindarajan R. Analysis of length of stay and treatment emergent complications in hospitalized myasthenia gravis patients with exacerbation. BMC Neurol. Published online January 12, 2023. doi:10.1186/s12883-022-02922-9