Morbidity after transsternal thymectomy for myasthenia gravis: a changing perspective?

A detailed assessment of recent changes in morbidity and mortality after transsternal thymectomy for myasthenia gravis is pending. To this end, a retrospective analysis was carried out of morbidity and mortality rates in 125 patients subjected to transsternal thymectomy for myasthenia gravis in the periods 1976-85 (1st decade) and 1986-95 (2nd decade). Composition of patients did not change much over time, except for more concomitant preoperative disease in the second decade (p = 0.001). None the less, complication rates were not higher, nor did the pattern of complications alter. Mortality was nil in both decades. There was no difference over the decades as to length of ventilation, intensive care treatment, or overall hospitalization. Most complications did not reveal a monocausal relationship, suggesting that a combination of risk factors was implicated. Further reductions in future morbidity rates after transsternal thymectomy for myasthenia gravis seem unlikely as patient preoperative state is unlikely to improve. In the light of the deteriorating preoperative patient condition, constant postoperative morbidity rates indicate that patient care has in fact improved.