Guillain-Barré syndrome after surgical procedures

Abstract

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.