<p>Surgery and Guillain-Barré Syndrome: A Single-Center Retrospective Study Focused on Clinical and Electrophysiological Subtypes</p>

Abstract

Background: Surgery-related Guillain-Barré syndrome (GBS) is often underestimated and sometimes difficult to diagnose. This study aimed to elucidate the clinical features and electrophysiological subtypes of post-surgical GBS. Methods: We retrospectively reviewed 17 patients who developed post-surgical GBS after a recent surgery between 2015 and 2019. Clinical characteristics, electrophysiological examinations, lumbar puncture results and prognosis were assessed. As controls, we selected 66 patients hospitalized with non-surgical GBS. Results: The median duration from the surgery to the onset of GBS symptoms was 16.0 days. The main types of surgeries preceding GBS were orthopedic, gastrointestinal and neurosurgery. Symmetrical distal limbs weakness was present in all 17 post-surgical GBS patients. The incidence of respiratory failure, autonomic dysfunction and muscle atrophy in post-surgical GBS patients was significantly higher than that in non-surgical GBS patients. Hughes Functional Grading Scale (HFGS) scores were also higher in the post-surgical GBS group both at the time of peak disease and 6 months after discharge. Electrophysiological studies revealed significant motor amplitudes reduction with relative preserved nerve conduction velocities and distal latencies, suggesting axonal subtypes of GBS. Conclusion: GBS should be considered in patients with rapidly progressive muscle weakness after surgery. Such patients often exhibit axonal subtypes of GBS with severe motor dysfunction, high risk of respiratory failure, and poor prognosis.

Predictors and Risk Factors of Severity of GBS, the Requirement for Mechanical Ventilation and Poor Short-Term Prognosis of Severe GBS

“…In addition, the breakdown of its innate protective barrier make antigens in blood entry into nervous system intraoperatively, so that the antigens trigger followed autoimmune responses [13].Nonetheless, to clearly clarify the pathogenesis need further research. Notwithstanding, in our study recent history of surgery was not statistically different between MV group and NV group, it was contradictory to the results of Lei Bao et al [10] which reported that acute respiratory failure and the requiement of MV in post-surgical GBS patients was meaningfully more common than non-surgical GBS patients, and came to the conclusion of higher respiratory depression of GBS induced by surgery.This difference might be due to the smaller sample size that was used in the present study.Next, we will enlarge the sample size to further clarify the relationship between surgery and respiratory failure.…”

“…Thus, identi cation of modi able risk factors for severe GBS in early stage of illness is of great important to help clinician to allocate appropriate unite and develop individualized treatment, which can make intensive care facilities use rationally and may decline the occur of residual sequelae and mortality. We found that recent history of surgery was most signi cant risk factor for severe GBS, it was in accordance with the result of Lei Bao et al [10,11] which demonstrated that GBS patients induced by surgery presented severe movement disorder and respiratory failure. The possible potential pathophysiological mechanisms of post-surgical GBS are not clearly known yet.…”

“…As classically described, poor prognosis is unfavourable in our study; Recent history of surgery, MRC at admission, MRC at nadir, the requirement of MV and pneumonia in hospitalization period are the risk factors which have been reported for poor outcome. Lei Bao et al [10] indicated patients with post-surgical GBS had poorer prognosis comparied with the patients with non-surgical GBS. Walgaard et al [18].…”

Trauma-Related Guillain–Barré Syndrome: Systematic Review of an Emerging Concept

“…Ninety-four studies involved a total of 136 patients diagnosed with GBS associated with trauma-related triggers, including injury, surgery, intracranial hemorrhage, and heatstroke, which were subjected to analysis ( Table 1). Six case series (15,(110)(111)(112)(113)(114) including trauma-related GBS patients with aggregated data were reviewed and generalized ( Table 2). Figure 1 shows the PRISMA flow diagram of the selection procedure of included studies.…”

“…A total of 100 publications ( 7 , 14 , 15 , 18 – 114 ) met the eligibility criteria for the review, 94 of which ( 7 , 14 , 18 – 109 ) included suitable data for analysis. Ninety-four studies involved a total of 136 patients diagnosed with GBS associated with trauma-related triggers, including injury, surgery, intracranial hemorrhage, and heatstroke, which were subjected to analysis ( Table 1 ).…”