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November 2016Research

Guillain-Barré syndrome after surgical procedures

Predisposing factors and outcome

Elanagan Nagarajan, Mark Rubin, Eelco F.M. Wijdicks, Sara E. Hocker
First published November 23, 2016, DOI: https://doi.org/10.1212/CPJ.0000000000000329
Elanagan Nagarajan
Department of Neurology (EN, EFMW, SEH), Mayo Clinic, Rochester, MN; Department of Neurology (MR), Northshore University Health System, Glenview, IL; and Department of Neurology, Mayo Clinic, Scottsdale, AZ.
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Mark Rubin
Department of Neurology (EN, EFMW, SEH), Mayo Clinic, Rochester, MN; Department of Neurology (MR), Northshore University Health System, Glenview, IL; and Department of Neurology, Mayo Clinic, Scottsdale, AZ.
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Eelco F.M. Wijdicks
Department of Neurology (EN, EFMW, SEH), Mayo Clinic, Rochester, MN; Department of Neurology (MR), Northshore University Health System, Glenview, IL; and Department of Neurology, Mayo Clinic, Scottsdale, AZ.
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Sara E. Hocker
Department of Neurology (EN, EFMW, SEH), Mayo Clinic, Rochester, MN; Department of Neurology (MR), Northshore University Health System, Glenview, IL; and Department of Neurology, Mayo Clinic, Scottsdale, AZ.
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Citation
Guillain-Barré syndrome after surgical procedures
Predisposing factors and outcome
Elanagan Nagarajan, Mark Rubin, Eelco F.M. Wijdicks, Sara E. Hocker
Neurol Clin Pract Nov 2016, 10.1212/CPJ.0000000000000329; DOI: 10.1212/CPJ.0000000000000329

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This article has corrections. Please see:

  • EXPRESSION OF CONCERN: Guillain-Barré syndrome after surgical procedures: Predisposing factors and outcomes - December 30, 2016
  • Editor's Note - June 01, 2018
  • Article
  • Info & Disclosures
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Abstract

Background: We sought to identify clinical associations and potential triggers of Guillain-Barré syndrome (GBS) within 8 weeks of surgical procedures.

Methods: We retrospectively reviewed consecutive patients diagnosed with GBS within 8 weeks of a surgical procedure between January 1995 and June 2014 at Mayo Clinic. Postsurgical GBS was defined as symptom onset within 8 weeks of a surgical procedure. Patients with postsurgical GBS were compared with patients who did not have a surgery or procedure prior to GBS onset to determine differences between groups.

Results: A total of 208 patients with GBS, median age 55 years (interquartile range [IQR] 41–68), were included. Thirty-one patients (15%) developed postsurgical GBS. Median duration from the surgery or procedure to onset of first GBS symptom was 19 days (IQR 11.1–37.5). The main types of surgeries/procedures preceding GBS were gastrointestinal, cardiac, and orthopedic. General anesthesia was used in 18 (58%) and conscious sedation in 13 (42%) patients. Among the 31 patients with postsurgical GBS, 19 (61%) had a known diagnosis of malignancy. Autoimmune conditions were present in 9 (29%) patients. Additional triggering factors were identified in 11 (35.5%) patients. On univariate analysis, the factors that showed an association with postsurgical GBS were age (p = 0.003), malignancy (p < 0.0001), active malignancy (p = 0.05), preexisting autoimmune disorder (p = 0.001), and duration of hospital stay (p = 0.015). On multivariate analysis, age (p = 0.045), malignancy (p < 0.0001), and preexisting autoimmune disorder (p = 0.004) remained associated.

Conclusions: Surgical procedures antedated GBS in 15% of patients, which is unexpectedly high. History of malignancy or autoimmune disease may predispose to development of postsurgical GBS.

  • Received June 3, 2016.
  • Accepted August 11, 2016.
  • © 2016 American Academy of Neurology

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