PT  - JOURNAL ARTICLE
AU  - Elanagan Nagarajan
AU  - Mark Rubin
AU  - Eelco F.M. Wijdicks
AU  - Sara E. Hocker
TI  - Guillain-Barré syndrome after surgical procedures
AID  - 10.1212/CPJ.0000000000000329
DP  - 2016 Nov 23
TA  - Neurology: Clinical Practice
PG  - 10.1212/CPJ.0000000000000329
4099  - http://cp.neurology.org/content/early/2016/11/23/CPJ.0000000000000329.short
4100  - http://cp.neurology.org/content/early/2016/11/23/CPJ.0000000000000329.full
AB  - 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.