Postoperative Complications Following Spine Surgery in Myasthenia Gravis Patients: A Propensity-Matched National Database Analysis

Study DesignRetrospective National Cohort Study.ObjectivesThis study aimed to evaluate complication profiles in myasthenia gravis (MG) versus non-MG patients across four routine spine surgeries: lumbar interbody fusion (LIF), lumbar decompression (LD), anterior cervical discectomy and fusion (ACDF), and posterior cervical decompression and fusion (PCDF).MethodsFrom 2010 to 2023, all LIF, LD, ACDF, or PCDF patients were queried from the PearlDiver Mariner Database using ICD-9/10 and CPT procedure codes. MG patients with prior thymectomy were excluded. Nearest-neighbor 3:1 propensity score matching based on age, sex, and comorbidity burden was performed. Postoperative complication rates were assessed during index hospitalization and 90 days postoperatively.ResultsAmong those included, 829, 1198, 527, and 129 MG patients underwent LIF, LD, ACDF, and PCDF, respectively. Understandably, MG patients had elevated rates of myasthenic crisis (5.4-8.5%) across all four cohorts at both time points. During initial hospital stay, MG patients had increased rates of pneumonia (4.0% vs 2.3%, p=0.017) and respiratory failure (4.9% vs 3.3%, p=0.016) following LIF and LD, respectively. Conversely, ACDF MG patients had decreased rates of CVA (0.9% vs 2.7%, p=0.028) and AKI (1.3% vs 3.5%, p=0.017). Similar trends were observed 90 days postoperatively. Length of stay was comparable across cohorts.ConclusionsMyasthenia gravis patients undergoing routine spine surgery face elevated risk of respiratory complications postoperatively. Other systemic complications rates were comparable following matching suggesting complication profiles may be surgery-specific rather than uniformly increased with MG. Appropriate preoperative optimization and multidisciplinary perioperative management allows for safe spine surgery in MG patients.