Background Thymectomy is established for myasthenia gravis (MG), but evidence from non-specialist general thoracic surgery units is limited. This study evaluates the feasibility and outcomes of thymectomy following an institutional transition from sternotomy to minimally invasive surgery, and assesses MG Composite and MG-ADL scores as longitudinal outcome measures. Methods A single-center retrospective cohort study of 58 consecutive patients who underwent MG thymectomy between 2018 and 2026. The primary outcome was favorable clinical status (complete stable remission or improvement) at 1 year. Secondary outcomes included complications, length of stay, medication reduction, and changes in MG Composite score. Between-group comparisons across surgical approaches are descriptive and exploratory only. Results Surgical approaches were robotic-assisted thoracic surgery (RATS; n = 29; 50.0%), video-assisted thoracoscopic surgery (VATS; n = 22; 37.9%), and sternotomy (n = 7; 12.1%). Perioperative mortality was zero. Overall complication rate was 10.3%. A favorable outcome was achieved in 68.9% (95% CI: 57.3-81.9%). Sternotomy was associated with longer hospital stay (median 7 vs. 2-3 days; p = 0.02). Prednisolone and pyridostigmine were reduced or discontinued in 72.1 and 55.3% of preoperative users, respectively (both p < 0.001). MG Composite and MG-ADL scores improved progressively from 3 months onward. Conclusion Thymectomy can be safely and effectively performed in a general thoracic surgery unit with appropriate specialist input, achieving outcomes comparable to regional referral centers. Apparently, transition to minimally invasive surgery did not compromise safety or efficacy while significantly reducing hospital stay. Future studies should collect MG Composite and MG-ADL scores prospectively as standardized outcome measures.
Background Non-steroidal anti-inflammatory drugs (NSAIDs) are a cornerstone of multimodal postoperative analgesia. However, their use remains controversial in surgery for spontaneous pneumothorax because inflammation plays a key role in the development of pleural symphysis during pleurodesis. This retrospective study aimed to evaluate the impact of postoperative NSAID administration after thoracoscopic surgery for spontaneous pneumothorax on chest drainage duration. Methods We conducted a monocentric retrospective observational study including patients who underwent video-assisted thoracoscopic surgery for spontaneous pneumothorax between January 1, 2015, and December 31, 2020. The primary endpoint was prolonged chest drainage, defined as drainage lasting >= 3 postoperative days. Secondary endpoints included early markers of pleural symphysis, postoperative analgesia, and postoperative complications. Results A total of 558 patients were included, of whom 245 (44%) received postoperative NSAIDs and 313 (56%) did not. In multivariable logistic regression, NSAIDs administration was significantly associated with a reduced riskof prolonged chest drainage (OR 0.62; 95%CI:0.44-0.89;p= 0.009). This association remained consistent after propensity score weighting (IPTW OR 0.66; 95%CI: 0.46-0.95) and sensitivity analyses. No significant differences were observed between the groups regarding postoperative complications or pleurodesis efficacy. The use of patient-controlled opioid analgesia was significantly lower in the NSAID group (p< 0.001). Conclusion Postoperative NSAID administration was associated with a reduced incidence of prolonged chest drainage, without evidence of worse early postoperative outcomes. These findings do not support impaired short-term pleural symphysis, although definitive conclusions on long-term pleurodesis efficacy would require prospective studies with extended follow-up.
Background: Inflammation plays an important role in the development of complications following coronary artery bypass graft (CABG) surgery. C-reactive protein-to-albumin (CRP/Alb) ratio is a novel biomarker that reflects the inflammatory burden and nutritional status. The present study aimed to investigate the utility of preoperative CRP/Alb ratio in predicting postoperative atrial fibrillation (POAF) and intensive care unit (ICU) length of stay in patients undergoing isolated CABG surgery. Methods: This retrospective study included 179 patients who underwent isolated CABG surgery between January 2019 and December 2023. Demographic characteristics, laboratory findings, surgical data, and postoperative outcomes were obtained from hospital records. Preoperative CRP/Alb ratios were calculated using serum CRP and albumin levels. The relationship of the CRP/Alb ratio with POAF development and ICU length of stay was evaluated. Results: During the study period, 26 patients (14.5%) experienced POAF. The preoperative CRP/Alb ratio was significantly associated with POAF development (p = 0.043), and patients who did not develop POAF had higher CRP/Alb ratios. Additionally, the CRP/Alb ratio exhibited a weak, albeit statistically significant, positive correlation with ICU length of stay (Spearman’s r = 0.186, p = 0.013). Conclusions: The preoperative CRP/Alb ratio was associated with the development of POAF and ICU length of stay in patients undergoing isolated CABG surgery. As an easily available, low-cost, and widely available biomarker, the CRP/Alb ratio may be useful for preoperative risk assessment in these patients. Key words: atrial fibrillation; C-reactive protein/albumin ratio; coronary artery bypass grafting; inflammation; intensive care unit; length of stay; postoperative
Objective: Postoperative atrial fibrillation (POAF) is a frequent complication after coronary artery bypass grafting (CABG) and is linked to increased short-and long-term stroke risk. This study evaluated the prognostic value of the left atrial diameter index (LADI) for predicting cerebrovascular events (CVE) in patients undergoing isolated CABG who developed POAF, had no prior atrial fibrillation (AF), and were discharged in sinus rhythm. Materials and methods: Among 2,094 patients undergoing isolated CABG between June 2015 and June 2022, 392 consecutive patients with POAF and discharge in sinus rhythm met inclusion criteria. LADI was calculated preoperatively, and an optimal cutoff (21.2 mm/m(2)) was determined via receiver operating characteristic curve and Youden index. Patients were classified as low (<= 21.2 mm/m(2)) or high (>21.2 mm/m(2)) LADI. The association between LADI and CVE was assessed over a mean follow-up of 42.4 +/- 20.0 months using Cox proportional hazards modeling. Results: Thirty patients (7.7%) experienced a CVE, including eight in-hospital cases (2.0%). CVE incidence was higher in the high LADI group compared with the low LADI group (19.8 vs. 2.8%). Multivariable analysis identified older age, hypertension, congestive heart failure, and high LADI as independent CVE predictors. Kaplan-Meier analysis confirmed significantly higher CVE rates in the high LADI group (log-rank, p < 0.001). Conclusion: In patients developing POAF after isolated CABG, LADI is a simple, easily obtainable parameter that independently predicts long-term CVE risk and may aid in postoperative risk stratification.
