Decade-long experience with surgical therapy of myasthenia gravis: Early complications of 324 transsternal thymectomies

Background. We studied the incidences and evaluated the management of early postoperative complications after thymectomy for myasthenia gravis. Methods. During the period between 1987 and 1996, 324 thymectomies were per formed through median sternotomy access under general anesthesia. Postopera tive management was administered according to a standardized protocol of an ticholinesterase medication, which was withdrawn for the 48 hours of obliga tory postoperative mechanical ventilation. The mean age of patients was 34 years (range, 8 to 71 years). Results. One hundred forty-nine patients made an uneventful recovery; 104 p atients had only minor complications, whereas 71 patients had major complic ations. The mortality rate was 0.6% (2 patients). The major surgical compli cations were recorded as sternal bleeding, (1 patient) and sternal disrupti on (1 patient). The major general complications were recorded as tracheal s tenosis (1 patient), pneumonia (3 patients), heart failure (1 patient), gas tric hemorrhage (1 patient), and respiratory insufficiency (71 patients). F orty-six reintubations were performed on 40 patients and 19 tracheostomies (6%) were performed postoperatively. Conclusions. The excessive incidence of respiratory insufficiency and airwa y-associated morbidity was potentially related, at least partially, to prol onged mechanical ventilation and withdrawal of anticholinesterase medicatio n. Earlier weaning of patients with revision of 48-hour withdrawal of antic holinesterase medication is necessary. (C) 2001 by The Society of Thoracic Surgeons.