Outcomes following single-level lumbar fusion in patients with myasthenia gravis

Patients with myasthenia gravis (MG) are at higher risk for postoperative complications after surgery. Knowledge concerning the impact of the condition on outcomes and complications after spine surgery is currently limited. Using a large-scale, national database, the purpose of this investigation was to compare the rate of medical and surgical complications, healthcare utilization, and need for revision surgery following single-level lumbar fusion between patients with and without MG.

Data was collected using the PearlDiver database and adult patients with and without MG who underwent single-level lumbar spine fusion from 2010 to 2022 were matched 1:4 on age, sex, and baselin comorbidities. Pearson's Chi-squared test and Welch's t-test were used to evaluate differences in demographic and clinical outcomes. Univariate analysis and multivariate logistic regression were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) after controlling for potential confounders.

A total of 537 (20.0%) patients with MG were matched with 2140 (80.0%) patients controls. At 90 days postoperatively, patients with MG experienced significantly higher rates of postoperative arrhythmia, cerebrovascular accident, atelectasis, respiratory failure, pleural effusion, pulmonary embolism, urinary retention, urinary tract infection, and renal failure. At two-year follow up, 27 (5.0%) patients with MG developed pseudoarthrosis compared to 48 (2.2%) controls (OR 2.32; 95% CI: 1.41-3.74; p < 0.001), and 38 (7.1%) MG patients had undergone revision lumbar spine surgery compared to 61 (2.9%) controls (OR: 2.61; 95% CI: 1.70-3.95; p < 0.001). Regarding healthcare utilization, patients with MG were more likely to present to the emergency department and require readmission at both 30 and 90 days postoperatively.

Patients with MG experienced more postoperative complications and higher healthcare utilization after single-level lumbar fusion. These findings highlight the importance of individualized perioperative planning to mitigate risks and inform surgeon counseling of patients and their families.