Introduction

• Myasthenia Gravis (MG) can be a paraneoplastic manifestation of Thymoma and surgical management is indicated to improve outcomes[1].
• 21% of patients with MG have thymomas [2]. Thymectomy is also indicated in non-diseased thymus to reduce long term pharmacotherapy exposure and improving outcomes. 
• As routine practice in our trust, thymectomy patients are cared on Intensive care unit (ICU) for routine post-operative care instead of ward/ high dependency unit.
• There is a risk of respiratory failure requiring re-intubation[3]. This has the implications including: cost, use of resources and cancellations due to lack of ITU beds

Objectives

• In this study we aim to evaluate if post-operative ITU care is required or can the patient’s be managed on the ward to prevent implications mentioned above.

Methods

•  Retrospective data analysis performed of MG patients undergoing thymectomy between 2009 and 2022. Parameters include:

1. Patient’s demographics
2. Length of stay (LOS) and management required in ICU
3. Post- operative complications
4. Procedure
5. Total LOS
6. Histology

 

Results

Total patients: Total Patients- 59 (Female: 78%(n=46) and Male: 22% (n=13))

Median Age- 48 years

 

Post-operative Complications

• Post-op complications were recorded in only 10% (n=6) patients, which included:
• Bleeding – requiring theatre, Phrenic nerve injury – diaphragm paralysis, Postoperative desaturation - requiring NIV in ITU , Arterial line abscess requiring prolonged hospital stay, Wound infection , Slow AF
• No patients required invasive ventilation post-op
• Average LOS in ITU was 1.05 days (± 0.08)
•  97% of the patients were stepped down to ward after one day in ICU
• Median length of stay (LOS) for post-op ICU recovery was 3.5 days compared 4 days for ward patients.
• Median LOS for VATS was 3 days, Robotic patients was 4 days and sternotomy was 7 days

Discussion

• Our results show most MG patient’s, post elective thymectomy can be managed on the ward/HDU
• Only 2 patient required ICU stay for more then 1 day
• LOS was longest with sternotomy patients when compared to VATS or robotic approach

Conclusions

In this study, post-thymectomy patients with MG did not require significant ICU intervention during routine post-operative stay.

 In selected number of patients, surgery can be performed without the need for routine post-op ICU admission. This will help to prevent cancellations due to ICU scarcity, providing cost effective and efficient service.