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Impact of surgery in patients with multiple sclerosis: a nationwide cohort study
Emma Larsson1,2, Ellen Iacobaeus3,4, Erik von Oelreich1,2
1Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Background:
Surgery is a common exposure. Multiple sclerosis (MS) is a chronic neuroinflammatory demyelinating disease of the central nervous system and a systemic inflammatory activation caused by surgery may result in exacerbation of the disease. It is unknown how surgical procedures affect morbidity and mortality rates in MS.
Objectives:
This study aimed to investigate morbidity associated with surgical interventions in MS patients by assessing disease burden before and after surgery. Non-MS patients were used as controls, allowing for comparisons of disease burden and mortality between the two groups.
Methods:
The cohort study analyzed data from the Swedish Perioperative Register, including 3,022 MS patients among over 1.5 million surgeries performed between January 2019 and March 2023. Disease burden was measured as the number of pre-specified ICD-codes before and after surgery.
Results:
We demonstrated that MS patients exhibited a higher mean number of diagnoses before and after surgery compared to controls. Specifically, the number of diagnoses peaked in the first month post-surgery but returned to baseline within three to 4 months. Notably, there were no significant differences in 30-day or 365-day mortality rates between MS and non-MS patients, highlighting the relative safety of surgical interventions for persons with MS.
Conclusion:
The findings suggest that surgery is generally safe for patients with MS, indicating that MS should not preclude necessary surgical interventions. Nevertheless, tailored preoperative assessments and postoperative care strategies are essential to address the unique health challenges encountered by MS patients, ensuring optimal surgical outcomes and monitoring for potential complications.
Insights
Surgery appears safe for multiple sclerosis (MS) patients, with no increased mortality risk observed. While MS patients had more diagnoses post-surgery, their disease burden returned to baseline within months, indicating careful management is key.
Area of Science:
- Neurology
- Surgical Outcomes
- Public Health
Background:
- Multiple sclerosis (MS) is a chronic neuroinflammatory disease.
- Surgery can trigger systemic inflammation, potentially exacerbating MS.
- The impact of surgery on MS morbidity and mortality is not well understood.
Purpose of the Study:
- To evaluate surgical morbidity in MS patients.
- To compare disease burden and mortality in MS vs. non-MS patients post-surgery.
Main Methods:
- A Swedish cohort study of over 1.5 million surgeries (2019-2023).
- Included 3,022 patients with MS and matched controls.
- Disease burden assessed by ICD-codes pre- and post-surgery.
Main Results:
- MS patients had a higher mean number of diagnoses pre- and post-surgery.
- Diagnosis peaks occurred within one month, returning to baseline by 3-4 months.
- No significant differences in 30-day or 365-day mortality between MS and non-MS patients.
Conclusions:
- Surgery is generally safe for individuals with MS.
- MS should not prevent necessary surgical procedures.
- Tailored preoperative and postoperative care is crucial for optimal outcomes in MS patients.
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