Safety for preoperative use of steroids for transsternal thymectomy in myasthenia gravisq

Objective: Effects of preoperative steroids on morbidity and mortality after transsternal thymectomy are analyzed. Methods: There were 620 transsternal thymectomies for myasthenia gravis performed in the period 1973–2002. There were 547 patients with nonthymomatous myasthenia, including 17 patients submitted to repeated thymectomy (rethymectomy) and 46 patients with thymoma. There were 522 upper median sternotomies performed in the period 1973–1997 and 98 complete median sternotomies performed in the period 1998–2002 (74 patients without thymoma, 7 thymomas and 17 rethymectomies). One hundred and seventeen of these 620 patients were taking steroids preoperatively. The impact of steroids use on postoperative respiratory insufficiency (ventilator), need for tracheostomy, superficial wound dehiscence, superficial wound suppuration, sternal dehiscence and mortality was analyzed. Results: The rate of morbidity and mortality in the steroids and the no-steroids groups included respiratory insufficiency necessitating the use of a ventilator in 46/503 patients from the no-steroids group (9.1%) and 8/117 patients from the steroids group (6.8%; P 0:4260), need for tracheostomy in 14/503 patients from the no-steroids group (2.8%) and 3/117 patients from the steroids group (2.6%; P 0:9054). Complications with wound healing (including sternal dehiscence, superficial wound dehiscence and superficial wound suppuration) occurred in 47/503 (9.3%) patients from the no-steroids group and in 1/117 (0.9%) patient from the steroids group ðP 0:0023Þ: The overall complications rate was 30.6 % (154/503) in the no-steroids group and 11.1 % (13/117) in the steroids group ðP 0:0001Þ: Mortality rate in the no-steroids group was 0.4 % (2/503 patients) and none in the steroids group. Morbidity in patients with complete sternotomy was low, respiratory insufficiency in three patients (3.1%), and superficia