title: Preoperative risk factors for prolonged postoperative ventilation following thymectomy in myasthenia gravis.
abstract: Adequate preoperative evaluation and preparation for surgery are required to prevent prolonged mechanical ventilation after thymectomy, and facilitate the recovery of patients with myasthenia gravis (MG). The objective of this study was to identify the preoperative risk factors for extubation failure after thymectomy in patients with MG.
  
  
  METHODS
  A retrospective study was conducted on 61 patients with MG who underwent extended thymectomy. Several factors were evaluated including patients' demographic data, preoperative medical therapies, medical history, and comorbidities. Multivariate logistic regression analysis was used to identify the predictors of late extubation after thymectomy for MG.
  
  
  RESULTS
  Fourteen patients (22.95%) required breathing support after anesthesia or endotracheal re-intubation within 48 h. Univariate analysis illustrated that the quantitative MG (QMG) grade (odds ratio [OR] = 1.368, P = 0.000), preoperative muscle strength (OR = 0.279, P = 0.000), use of pyridostigmine (OR = 1.011, P = 0.024) and prednisone (OR = 1.059, P = 0.022), preoperative lung function (OR = 4.875, P = 0.016), low preoperative cholinesterase levels (OR = 0.999, P = 0.014), impaired preoperative swallowing muscle activity (OR = 7.619, P = 0.003), and positivity for acetylcholine receptor antibodies (OR = 14.143, P = 0.001) were significant predictors of prolonged postoperative intubation. Multivariate logistic regression analysis revealed that the QMG score (OR = 3.408, P = 0.000) and Myasthenia Gravis Foundation of America (MGFA) classification (OR = 28.683, P = 0.002) were independent risk factors for prolonged postoperative intubation.
  
  
  CONCLUSIONS
  The preoperative MGFA clinical classification and QMG score were independent risk factors for prolonged postoperative intubation in patients with MG.
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, Yijishan Hospital, First Affiliated Hospital of Wannan Medical College Wuhu 241001, Anhui, China.
authors.forename: Weihua
authors.initials: W
authors.lastname: Lu
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, Yijishan Hospital, First Affiliated Hospital of Wannan Medical College Wuhu 241001, Anhui, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Yu
authors.affiliation: Department of Translational Medicine, Eastern Piedmont University "A. Avogadro" Novara, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Longhini
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, Yijishan Hospital, First Affiliated Hospital of Wannan Medical College Wuhu 241001, Anhui, China.
authors.forename: Xiaogan
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, Yijishan Hospital, First Affiliated Hospital of Wannan Medical College Wuhu 241001, Anhui, China.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Qin
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, Yijishan Hospital, First Affiliated Hospital of Wannan Medical College Wuhu 241001, Anhui, China.
authors.forename: Xiaoju
authors.initials: X
authors.lastname: Jin
keywords: Myasthenia gravis; airway extubation; risk factors; thymectomy